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NPI Code Detail

MEDICARE: DR. DANIEL W MOULLET MD

MEDICARE: DR. DANIEL W MOULLET MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD00034152WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1114507OTHERL & I
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790773802
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIEL W MOULLET MD
Provider Business Mailing Address
First Line : 1200 E COLUMBIA AVE
Second Line :
City : COLVILLE
State : WA
Zip : 99114-3354
Country : US
Telephone Number : 509-684-3701
Fax Number : 509-684-5817
Provider Business Practice Location Address
First Line : 107 6TH AVE SW
Second Line :
City : RONAN
State : MT
Zip : 59864-2634
Country : US
Telephone Number : 406-676-4441
Fax Number : 406-676-0835
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2005
Last Update Date : 09/13/2013

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