Provider Demographics
NPI:1891766598
Name:MOTOS, RICHARD R (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:MOTOS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 S JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6136
Mailing Address - Country:US
Mailing Address - Phone:559-734-1171
Mailing Address - Fax:559-734-6849
Practice Address - Street 1:308 S JOHNSON ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6136
Practice Address - Country:US
Practice Address - Phone:559-734-1171
Practice Address - Fax:559-734-6849
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4791213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532405OtherBLUE CROSS BLUE SHIELD
ILP00391070OtherRAILROAD MEDICARE
WI43237700Medicaid
0732240001OtherDMERC # WITH PPG
WI43237700Medicaid
CAV00426Medicare UPIN
WI43237700Medicaid
WI000781015Medicare PIN
WI001286533Medicare PIN
WI001085070Medicare PIN
WIP00172464Medicare PIN
WI$$$$$$$$$003OtherBC/BS WI (363885637015)
CA0674340001Medicare NSC
WI001486481Medicare PIN
IL04532405OtherBLUE CROSS BLUE SHIELD
ILK11587Medicare PIN
WI000881435Medicare PIN