Provider Demographics
NPI:1912025594
Name:MOTCHAN, DENNIS G (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:G
Last Name:MOTCHAN
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 1:8340 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63147-2333
Mailing Address - Country:US
Mailing Address - Phone:314-385-9563
Mailing Address - Fax:314-385-9350
Practice Address - Street 1:8340 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63147-2333
Practice Address - Country:US
Practice Address - Phone:314-385-9563
Practice Address - Fax:314-385-9350
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO61542083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA14051Medicare UPIN