Provider Demographics
NPI:1295776201
Name:MOTT, KEVIN JOHN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOHN
Last Name:MOTT
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:PO BOX 7643
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-0643
Mailing Address - Country:US
Mailing Address - Phone:970-663-2742
Mailing Address - Fax:970-342-2093
Practice Address - Street 1:1708 BOISE AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4204
Practice Address - Country:US
Practice Address - Phone:970-667-3116
Practice Address - Fax:970-669-0159
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO53082207N00000X, 207ND0101X
HI6814207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIE0089663OtherHMSA
E88769Medicare UPIN
HIE0089663OtherHMSA