Healthcare Provider Details

I. General information

NPI: 1346217056
Provider Name (Legal Business Name): CHRISTOPHER E MOLITOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 ASHLAND AVE STE A
WARRENTON MO
63383-1065
US

IV. Provider business mailing address

511 ASHLAND AVE STE A
WARRENTON MO
63383-1065
US

V. Phone/Fax

Practice location:
  • Phone: 636-456-0543
  • Fax: 636-456-1681
Mailing address:
  • Phone: 636-456-0543
  • Fax: 636-456-1681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2005005181
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: