Healthcare Provider Details

I. General information

NPI: 1750447215
Provider Name (Legal Business Name): R. MOLLIE A. JOHN, M.D., APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 BRIERFIELD DR
MONROE LA
71201-3048
US

IV. Provider business mailing address

2701 BRIERFIELD DR
MONROE LA
71201-3048
US

V. Phone/Fax

Practice location:
  • Phone: 318-387-1437
  • Fax: 318-322-2685
Mailing address:
  • Phone: 318-387-1437
  • Fax: 318-322-2685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number10383R
License Number StateLA

VIII. Authorized Official

Name: DR. R. MOLLIE A. JOHN
Title or Position: PRESIDENT
Credential: MD.
Phone: 318-387-1437