Healthcare Provider Details

I. General information

NPI: 1598037764
Provider Name (Legal Business Name): JEREMY MICHAEL LAMOTHE MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF ORTHOPAEDICS, 3330 HOSPITAL DRIVE NW
CALGARY ALBERTA
T2N4N1
CA

IV. Provider business mailing address

2306 ERLTON PL SW
CALGARY ALBERTA
T2S2Z4
CA

V. Phone/Fax

Practice location:
  • Phone: 403-464-9374
  • Fax:
Mailing address:
  • Phone: 403-464-9374
  • Fax: 403-245-9374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberALBERTA: 019533
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: