Provider Demographics
NPI:1578591590
Name:LOTAN, ORI M (MD)
Entity Type:Individual
Prefix:
First Name:ORI
Middle Name:M
Last Name:LOTAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-2079
Mailing Address - Country:US
Mailing Address - Phone:903-416-4374
Mailing Address - Fax:903-416-4380
Practice Address - Street 1:1014 MEMORIAL DR
Practice Address - Street 2:HOSPITALIST PROGRAM
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020
Practice Address - Country:US
Practice Address - Phone:903-416-4378
Practice Address - Fax:903-416-4380
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2743207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045422506Medicaid
TX045422506Medicaid
TX8C6264Medicare ID - Type Unspecified