MEDICARE: PHILIP J MOTEVOSIAN

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1255287942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP J MOTEVOSIAN

Provider Business Mailing Address
First Line	:	4125 FAIRWAY DR STE 150
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75010-6511
Country	:	US
Telephone Number	:	940-999-0120
Fax Number	:	945-223-2308

Provider Business Practice Location Address
First Line	:	4125 FAIRWAY DR STE 150
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75010-6511
Country	:	US
Telephone Number	:	940-999-0120
Fax Number	:	945-223-2308

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

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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