Provider Demographics
NPI:1598945693
Name:MOTZ, ERIC JAMES (IDC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JAMES
Last Name:MOTZ
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 LOWER GAINESVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:STENNIS SPACE CENTER
Mailing Address - State:MS
Mailing Address - Zip Code:39529-0001
Mailing Address - Country:US
Mailing Address - Phone:843-252-8035
Mailing Address - Fax:
Practice Address - Street 1:2603 LOWER GAINESVILLE ROAD
Practice Address - Street 2:
Practice Address - City:STENNIS SPACE CENTER
Practice Address - State:MS
Practice Address - Zip Code:39529-0001
Practice Address - Country:US
Practice Address - Phone:843-252-8035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman