Healthcare Provider Details

I. General information

NPI: 1114772217
Provider Name (Legal Business Name): JOSHUA MOTON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 W WHEATLAND RD
DALLAS TX
75237-3460
US

IV. Provider business mailing address

3500 W WHEATLAND RD
DALLAS TX
75237-3460
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-5420
  • Fax: 214-947-5425
Mailing address:
  • Phone: 214-947-5420
  • Fax: 214-947-5425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10090311
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: