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General NPI Number Information
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NPI Number | 1265705925
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Entity Type | Organization
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Legal Business Name | GARY MOTYKIE, M.D. A MEDICAL CORPORATION
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Dates
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Enumeration Date | 02/10/2012
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 9201 W SUNSET BLVD SUITE GF-1
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City | LOS ANGELES
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State | CA
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Zip | 90069-3701
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Country | US
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Telephone | 310-246-2355
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Fax |
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Provider Business Mailing Address
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Address Line | 9201 W SUNSET BLVD SUITE GF-1
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City | LOS ANGELES
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State | CA
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Zip | 90069-3701
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Country | US
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Telephone | 310-246-2355
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. GARY MOTYKIE
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Credential | M.D.
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Telephone | 310-246-2355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | A87356
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License Number State | CA
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