Provider Demographics
NPI:1265462121
Name:LOTT, BRADLEY J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:J
Last Name:LOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1570 CROCKETT DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-7347
Mailing Address - Country:US
Mailing Address - Phone:214-578-8848
Mailing Address - Fax:214-872-1036
Practice Address - Street 1:1570 CROCKETT DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7347
Practice Address - Country:US
Practice Address - Phone:214-578-8848
Practice Address - Fax:214-872-1036
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4501207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104329101Medicaid
TX104329101Medicaid
TX84G657Medicare ID - Type UnspecifiedPROVIDER