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General NPI Number Information
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NPI Number | 1356506851
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Entity Type | Organization
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Legal Business Name | ROBERT J LOTSTEIN
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Dates
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Enumeration Date | 07/23/2008
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Last Update Date | 07/23/2008
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Provider Practice Location Address
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Address Line | 332 5TH ST
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City | LEWISTON
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State | ID
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Zip | 83501-2408
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Country | US
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Telephone | 208-743-7955
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Fax | 208-743-7957
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Provider Business Mailing Address
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Address Line | 332 5TH ST
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City | LEWISTON
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State | ID
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Zip | 83501-2408
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Country | US
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Telephone | 208-743-7955
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Fax | 208-743-7957
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT J LOTSTEIN
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Credential | M.D.
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Telephone | 208-743-7955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | M6559
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License Number State | ID
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