Healthcare Provider Details

I. General information

NPI: 1235124546
Provider Name (Legal Business Name): WANDA THORTON MOTT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 08/06/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 MAIN ST SUITE H1300
HOUSTON TX
77030-2331
US

IV. Provider business mailing address

6620 MAIN ST SUITE H1300
HOUSTON TX
77030-2331
US

V. Phone/Fax

Practice location:
  • Phone: 713-797-1144
  • Fax: 832-825-7775
Mailing address:
  • Phone: 713-797-1144
  • Fax: 832-825-7775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberE8744
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: