Provider Demographics
NPI:1578616157
Name:LOTT, TREY D (MD)
Entity Type:Individual
Prefix:
First Name:TREY
Middle Name:D
Last Name:LOTT
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 1:1011 GREYMOOR RD
Mailing Address - Street 2:
Mailing Address - City:SHOAL CREEK
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7210
Mailing Address - Country:US
Mailing Address - Phone:205-991-5577
Mailing Address - Fax:
Practice Address - Street 1:2010 PATTON CHAPEL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-5782
Practice Address - Country:US
Practice Address - Phone:205-822-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19369208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG18344Medicare UPIN