Provider Demographics
NPI:1467413203
Name:MOTEN, GREGORY (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:MOTEN
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 1:174 CURRIE HALL PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4387
Mailing Address - Country:US
Mailing Address - Phone:330-548-0086
Mailing Address - Fax:
Practice Address - Street 1:174 CURRIE HALL PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-4387
Practice Address - Country:US
Practice Address - Phone:330-548-0086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004242207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMO0705996Medicare ID - Type Unspecified