Healthcare Provider Details

I. General information

NPI: 1992740179
Provider Name (Legal Business Name): RODGER EUGENE MOLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S RIDGECREST
NIXA MO
65714
US

IV. Provider business mailing address

105 S RIDGECREST
NIXA MO
65714
US

V. Phone/Fax

Practice location:
  • Phone: 417-725-8250
  • Fax: 417-724-3185
Mailing address:
  • Phone: 417-725-8250
  • Fax: 417-724-3185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR9565
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: