Healthcare Provider Details

I. General information

NPI: 1063499440
Provider Name (Legal Business Name): LYNDA L MOLLOY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 E. PRATER WAY
SPARKS NV
89434-9641
US

IV. Provider business mailing address

2345 E PRATER WAY STE 207
SPARKS NV
89434-9634
US

V. Phone/Fax

Practice location:
  • Phone: 775-352-5301
  • Fax: 775-352-5303
Mailing address:
  • Phone: 775-352-5301
  • Fax: 775-352-5303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10516
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: