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General NPI Number Information
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NPI Number | 1750447215
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Entity Type | Organization
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Legal Business Name | R. MOLLIE A. JOHN, M.D., APMC
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 07/19/2010
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Provider Practice Location Address
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Address Line | 2701 BRIERFIELD DR
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City | MONROE
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State | LA
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Zip | 71201-3048
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Country | US
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Telephone | 318-387-1437
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Fax | 318-322-2685
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Provider Business Mailing Address
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Address Line | 2701 BRIERFIELD DR
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City | MONROE
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State | LA
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Zip | 71201-3048
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Country | US
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Telephone | 318-387-1437
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Fax | 318-322-2685
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. R. MOLLIE A. JOHN
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Credential | MD.
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Telephone | 318-387-1437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 10383R
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License Number State | LA
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