Healthcare Provider Details

I. General information

NPI: 1124550488
Provider Name (Legal Business Name): JONATHAN ADAM BERYMAN MOTTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-3605
  • Fax:
Mailing address:
  • Phone: 206-543-3605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number85197
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2020-03111
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60964067
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: