Provider Demographics
NPI:1699774455
Name:MOTTO, EDWIN V (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:V
Last Name:MOTTO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1228 E RUSHOLME ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2467
Mailing Address - Country:US
Mailing Address - Phone:563-326-6273
Mailing Address - Fax:563-326-0098
Practice Address - Street 1:1228 E RUSHOLME ST
Practice Address - Street 2:SUITE 310
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2467
Practice Address - Country:US
Practice Address - Phone:563-326-6273
Practice Address - Fax:563-326-0098
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IA21256207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A01718Medicare UPIN