Individual
CHARLES FLOYD MOTLEY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6916 W JOHNSON RD, LA PORTE, IN 46350-8247
(219) 872-7247
(219) 879-8609
Mailing address
6916 W JOHNSON RD, LA PORTE, IN 46350-8247
(219) 872-7247
(219) 879-8609
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01030248B
IN
2084P0800X
Psychiatry Physician
01030248A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000316332
ANTHEM BLUE CROSS
—
05
—
100163900A
—
IN
Enumeration date
08/09/2005
Last updated
04/22/2008
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