Provider Demographics
NPI:1326174004
Name:MOTYCKOVA, GABRIELA (MD, PHD)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:MOTYCKOVA
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TH AVENUE AND C ST
Mailing Address - Street 2:BLOOD AND MARROW TRANSPLANT/LEUKEMIA PROGRAM
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84143-0001
Mailing Address - Country:US
Mailing Address - Phone:801-408-3043
Mailing Address - Fax:
Practice Address - Street 1:8TH AVENUE AND C STREET
Practice Address - Street 2:BLOOD AND MARROW TRANSPLANT/LEUKEMIA PROGRAM
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-0001
Practice Address - Country:US
Practice Address - Phone:801-408-3043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA234610207R00000X, 207RH0000X, 207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology