Provider Demographics
NPI:1558859884
Name:LOTT, DAVID EARL III (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EARL
Last Name:LOTT
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4040
Mailing Address - Country:US
Mailing Address - Phone:601-553-6000
Mailing Address - Fax:601-703-0124
Practice Address - Street 1:2024 15TH STREET, 5TH FLOOR, MEDICAL TOWER I
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301
Practice Address - Country:US
Practice Address - Phone:601-553-6399
Practice Address - Fax:601-703-8398
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-3606207R00000X
390200000X
MS29052207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program