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General NPI Number Information
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NPI Number | 1013071794
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Entity Type | Individual
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Provider Name | JACOB THEODOOR MOLL M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 723 PINEY FOREST RD
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City | DANVILLE
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State | VA
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Zip | 24540-2860
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Country | US
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Telephone | 434-773-6830
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Fax | 434-773-6832
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Provider Business Mailing Address
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Address Line | 570 COUNTRY PLACE RD
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City | AXTON
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State | VA
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Zip | 24054-2566
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Country | US
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Telephone | 276-666-5908
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Fax | 276-666-5908
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number | 0101019920
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License Number State | VA
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