Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1559 | TX |
Y | 222Z00000X | Podiatrist | 1559 | TX |
N | 213ES0103X | Foot & Ankle Surgery | 1559 | TX |
NPI | 1003850991 |
---|---|
Provider Name | Travis A Motley |
First Address | Dallas, TX 75373-2973 |
Second Address | Fort Worth, TX 76104-7305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 29/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
159461601 | (05) | TX |
8K7417 | BCBS (01) | TX |
P00258969 | RAILROAD MEDICARE (01) | TX |
U95857 | (02) | TX |