Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 32598 | WI |
NPI | 1043287717 |
---|---|
Provider Name | Robert Michael Molloy |
First Address | Milwaukee, WI 53215-3600 |
Second Address | Wauwatosa, WI 53226-3442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 25/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32307800 | (05) | WI |
F58379 | (02) | WI |