Healthcare Provider Details

I. General information

NPI: 1316357163
Provider Name (Legal Business Name): SCOTT LOTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E ROOSEVELT ST
PHOENIX AZ
85008-4973
US

IV. Provider business mailing address

2601 E. ROOSEVELT ST. MARICOPA INTEGRATED HEALTH SYSTEM
PHOENIX AZ
85008
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-1015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number54352
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: