Provider Demographics
NPI:1104811843
Name:MOTYKA, TRACY M (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:M
Last Name:MOTYKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:DRAWER 141
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 SIVLEY RD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4421
Practice Address - Country:US
Practice Address - Phone:256-265-9905
Practice Address - Fax:256-265-9910
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00026243207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1340070OtherBCBS
AL009936154Medicaid
AL051524416OtherBCBS
AL7225473OtherAETNA
AL051524416Medicaid
AL051524418OtherBCBS PROVIDER NUMBER
AL051524418Medicaid
AL009936154Medicaid
AL051524418Medicare PIN
AL051524418Medicaid
AL051524416Medicare PIN