MEDICARE: LAURA MOTARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207P00000X	Emergency Medicine Physician	W3846	TX

General Provider Information

NPI Number	:	1255089827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MOTARD

Provider Business Mailing Address
First Line	:	4035 GRENNOCH LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-2301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6410 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3000
Country	:	US
Telephone Number	:	832-325-7080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2022
Last Update Date	:	05/27/2026

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Directions to “ LAURA MOTARD ” Practice Location

Language	Start Address	Practice Location

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