Provider Demographics
NPI:1003038811
Name:MOLLMAN, BURTON J (PA-C)
Entity Type:Individual
Prefix:
First Name:BURTON
Middle Name:J
Last Name:MOLLMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:4401 COLEMAN ST STE 107
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1371
Mailing Address - Country:US
Mailing Address - Phone:701-751-4340
Mailing Address - Fax:701-751-4332
Practice Address - Street 1:4401 COLEMAN ST STE 107
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1371
Practice Address - Country:US
Practice Address - Phone:701-751-4340
Practice Address - Fax:701-751-4340
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NDPAC0418363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant