Healthcare Provider Details

I. General information

NPI: 1285734814
Provider Name (Legal Business Name): ANGELA RUTH MOTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 HILL RD
SMITHVILLE TX
78957
US

IV. Provider business mailing address

PO BOX 1977
BASTROP TX
78602-8977
US

V. Phone/Fax

Practice location:
  • Phone: 512-237-5736
  • Fax:
Mailing address:
  • Phone: 573-231-4993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberP5304
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: