Provider Demographics
NPI:1043283088
Name:MOLES, RODGER BROOKS (MS)
Entity Type:Individual
Prefix:MR
First Name:RODGER
Middle Name:BROOKS
Last Name:MOLES
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 S COLBY AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-3215
Mailing Address - Country:US
Mailing Address - Phone:660-831-5428
Mailing Address - Fax:
Practice Address - Street 1:1601 S COLBY AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3215
Practice Address - Country:US
Practice Address - Phone:660-815-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002823101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO32599016OtherBCBS