Individual
MRS. MARY E LOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2606 PARK ST, JACKSONVILLE, FL 32204-4520
(904) 388-4646
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(904) 388-4646
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
62137
GA
208000000X
Pediatrics Physician
Primary
ME131370
FL
2080H0002X
Pediatric Hospice and Palliative Medicine Physician
001265
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001265
RESIDENCY LICENSE
GA
05
—
369518390E
—
GA
01
—
52319773
BCBS
GA
01
—
GRP2665
EMPLOYER ID
GA
01
—
PENDING
MEDICARE
FL
Enumeration date
04/18/2007
Last updated
07/21/2022
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