Provider Demographics
NPI:1598037764
Name:LAMOTHE, JEREMY MICHAEL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:MICHAEL
Last Name:LAMOTHE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 ERLTON PL SW
Mailing Address - Street 2:
Mailing Address - City:CALGARY
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T2S2Z4
Mailing Address - Country:CA
Mailing Address - Phone:403-464-9374
Mailing Address - Fax:403-245-9374
Practice Address - Street 1:DEPARTMENT OF ORTHOPAEDICS, 3330 HOSPITAL DRIVE NW
Practice Address - Street 2:
Practice Address - City:CALGARY
Practice Address - State:ALBERTA
Practice Address - Zip Code:T2N4N1
Practice Address - Country:CA
Practice Address - Phone:403-464-9374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZALBERTA: 019533390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program