Healthcare Provider Details

I. General information

NPI: 1740644871
Provider Name (Legal Business Name): MOLLY LOUISE ALEXANDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 S CHIPETA WAY
SALT LAKE CITY UT
84108
US

IV. Provider business mailing address

PO BOX PH
CHINLE AZ
86503-8000
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-3469
  • Fax:
Mailing address:
  • Phone:
  • Fax: 928-674-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number112678601205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: