Healthcare Provider Details

I. General information

NPI: 1689676512
Provider Name (Legal Business Name): DANIEL J. LAMOTHE-JOST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N KEENE ST
COLUMBIA MO
65201-6625
US

IV. Provider business mailing address

401 KEENE ST
COLUMBIA MO
65201-6625
US

V. Phone/Fax

Practice location:
  • Phone: 573-876-1622
  • Fax: 573-876-1629
Mailing address:
  • Phone: 573-876-1622
  • Fax: 573-876-1629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number110877
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number110877
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: