1093165789 NPI number — DR. MARK WHITNEY MOTEJUNAS M.D.

Table of content: DR. MARK WHITNEY MOTEJUNAS M.D. (NPI 1093165789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093165789 NPI number — DR. MARK WHITNEY MOTEJUNAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOTEJUNAS
Provider First Name:
MARK
Provider Middle Name:
WHITNEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093165789
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1224
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SLIDELL
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70459-1224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-882-4500
Provider Business Mailing Address Fax Number:
985-661-6218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
64301 HIGHWAY 434
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LACOMBE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70445-5411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-882-4500
Provider Business Practice Location Address Fax Number:
985-882-4501
Provider Enumeration Date:
06/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  A166567 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: 326211 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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