Provider Demographics
NPI:1134238975
Name:MOTLEY, REGINALD ZANE (DO)
Entity type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:ZANE
Last Name:MOTLEY
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 1:100 RICE MINE RD N
Mailing Address - Street 2:SUITE B
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2300
Mailing Address - Country:US
Mailing Address - Phone:205-439-4200
Mailing Address - Fax:
Practice Address - Street 1:100 RICE MINE RD N
Practice Address - Street 2:SUITE B
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2300
Practice Address - Country:US
Practice Address - Phone:205-439-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528502230Medicaid
ALG82896Medicare UPIN
AL528502230Medicaid