Provider Demographics
NPI:1235124546
Name:MOTT, WANDA THORNTON (MD)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:THORNTON
Last Name:MOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6624 FANNIN ST
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2312
Mailing Address - Country:US
Mailing Address - Phone:713-797-1144
Mailing Address - Fax:713-425-3072
Practice Address - Street 1:6651 MAIN ST STE F1500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-797-1144
Practice Address - Fax:832-825-7775
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8744207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD67458Medicare UPIN