Provider Demographics
NPI:1336415827
Name:LAMOTHE, MARIE (DO)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:LAMOTHE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:LAMOTHE-JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:954-431-8000
Mailing Address - Fax:954-436-0449
Practice Address - Street 1:400 N HIATUS RD STE 105
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5214
Practice Address - Country:US
Practice Address - Phone:954-431-8000
Practice Address - Fax:954-436-0449
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14531208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021877300Medicaid