Individual
JEFFREY CHARLES MOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-2900
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA05621
TX
363AS0400X
Surgical Physician Assistant
PA05621
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
333223101
—
TX
01
—
8007NJ
BCBS
TX
Enumeration date
10/23/2006
Last updated
08/19/2014
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