Provider Demographics
NPI:1356506851
Name:ROBERT J LOTSTEIN
Entity Type:Organization
Organization Name:ROBERT J LOTSTEIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOTSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-743-7955
Mailing Address - Street 1:332 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2408
Mailing Address - Country:US
Mailing Address - Phone:208-743-7955
Mailing Address - Fax:208-743-7957
Practice Address - Street 1:332 5TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2408
Practice Address - Country:US
Practice Address - Phone:208-743-7955
Practice Address - Fax:208-743-7957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6559174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1119023Medicaid
ID003799200Medicaid
WA1119023Medicaid