Provider Demographics
NPI:1720037443
Name:MOTTA, MICHAEL RICHARD (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RICHARD
Last Name:MOTTA
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 1:7777 FOREST LANE
Mailing Address - Street 2:SUITE B222
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230
Mailing Address - Country:US
Mailing Address - Phone:972-566-7007
Mailing Address - Fax:972-566-7013
Practice Address - Street 1:7777 FOREST LANE
Practice Address - Street 2:SUITE B222
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:972-566-7007
Practice Address - Fax:972-566-7013
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4965207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00991919OtherRAILROAD
TX102698104Medicaid
TX102698103Medicaid
TX102698104Medicaid
G01468Medicare UPIN