Provider Demographics
NPI:1003850991
Name:MOTLEY, TRAVIS A (DPM)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:A
Last Name:MOTLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 732973
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2973
Mailing Address - Country:US
Mailing Address - Phone:817-702-8450
Mailing Address - Fax:
Practice Address - Street 1:800 5TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7305
Practice Address - Country:US
Practice Address - Phone:817-702-9100
Practice Address - Fax:817-882-9242
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1559213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159461601Medicaid
TXP00258969OtherRAILROAD MEDICARE
TX8K7417OtherBCBS
TX8K7417OtherBCBS
TXP00258969OtherRAILROAD MEDICARE