Provider Demographics
NPI:1578705653
Name:MOTTO, AMANDA M (DO)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:M
Last Name:MOTTO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5359 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2738
Mailing Address - Country:US
Mailing Address - Phone:563-742-5900
Mailing Address - Fax:563-742-5905
Practice Address - Street 1:5359 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2738
Practice Address - Country:US
Practice Address - Phone:563-742-5900
Practice Address - Fax:563-742-5905
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1578705653Medicaid
IA719260372Medicare PIN
IA1578705653Medicaid