Provider Demographics
NPI:1679673057
Name:LAMOTHE, JACQUES J (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUES
Middle Name:J
Last Name:LAMOTHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4285 SE FRAZIER CT
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5679
Mailing Address - Country:US
Mailing Address - Phone:702-523-7599
Mailing Address - Fax:
Practice Address - Street 1:1900 NEBRASKA AVE STE 9
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4837
Practice Address - Country:US
Practice Address - Phone:772-465-4499
Practice Address - Fax:772-466-0832
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20494207RC0000X
NV7158207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1679673057Medicaid
NVEX460 X (CQ328A)Medicare PIN
NVF70714Medicare UPIN
NV1679673057Medicaid