Provider Demographics
NPI:1598830341
Name:JAMES R. MOTLAGH, M.D., P.A.
Entity Type:Organization
Organization Name:JAMES R. MOTLAGH, M.D., P.A.
Other - Org Name:TYLER PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOTLAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-526-2500
Mailing Address - Street 1:700 OLYMPIC PLAZA CIRCLE
Mailing Address - Street 2:STE 420
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701
Mailing Address - Country:US
Mailing Address - Phone:903-526-2500
Mailing Address - Fax:903-526-2535
Practice Address - Street 1:700 OLYMPIC PLAZA CIRCLE
Practice Address - Street 2:STE 420
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-526-2500
Practice Address - Fax:903-526-2535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4071208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A1039OtherBLUE CROSS BLUE SHIELD
TXH20526Medicare UPIN
TXTXB129886Medicare PIN