Healthcare Provider Details

I. General information

NPI: 1962471177
Provider Name (Legal Business Name): PATRICK EDWARD MOTTRAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E JUDGE PEREZ DR
CHALMETTE LA
70043-5405
US

IV. Provider business mailing address

360 OAK HARBOR BLVD
SLIDELL LA
70458-5702
US

V. Phone/Fax

Practice location:
  • Phone: 504-333-6988
  • Fax: 504-342-2184
Mailing address:
  • Phone: 985-726-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.03279R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: