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General NPI Number Information
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NPI Number | 1942566195
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Entity Type | Individual
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Provider Name | EDWARD GREGORY MOELLMER MD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2012
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 6640 KANIKSU ST
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City | BONNERS FERRY
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State | ID
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Zip | 83805-7532
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Country | US
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Telephone | 208-267-3141
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Fax | 208-267-2202
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Provider Business Mailing Address
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Address Line | 802 2ND ST NW
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City | BOWMAN
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State | ND
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Zip | 58623-4483
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Country | US
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Telephone | 701-523-5555
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Fax | 701-523-7107
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14045
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 99946
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M-13338
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License Number State | ID
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