Provider Demographics
NPI:1588081087
Name:MOTL, JOSHUA E (PA-C)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:E
Last Name:MOTL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14534 W HIDDEN TERRACE LOOP
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-0989
Mailing Address - Country:US
Mailing Address - Phone:218-371-9340
Mailing Address - Fax:
Practice Address - Street 1:20172 E STAGECOACH TRL
Practice Address - Street 2:
Practice Address - City:CORDES LAKES
Practice Address - State:AZ
Practice Address - Zip Code:86333
Practice Address - Country:US
Practice Address - Phone:928-632-4399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5678363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ912701Medicaid