Provider Demographics
NPI:1073575924
Name:MOTTA, PAUL C (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:MOTTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 W MAIN ST STE 403
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1314
Mailing Address - Country:US
Mailing Address - Phone:334-671-2855
Mailing Address - Fax:334-793-1561
Practice Address - Street 1:4300 W MAIN ST STE 403
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1314
Practice Address - Country:US
Practice Address - Phone:334-671-2855
Practice Address - Fax:334-793-1561
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYDO-381174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL030004735OtherRAILROAD MEDICARE
AL000008838Medicaid
AL051008838OtherBCBS AL
AL000008838Medicaid
AL030004735OtherRAILROAD MEDICARE