Provider Demographics
NPI:1083856173
Name:MOLLER, JEFFREY LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LAWRENCE
Last Name:MOLLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26009 N 19TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8698
Mailing Address - Country:US
Mailing Address - Phone:360-770-8176
Mailing Address - Fax:
Practice Address - Street 1:9305 W THOMAS RD STE 465
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3357
Practice Address - Country:US
Practice Address - Phone:480-745-3547
Practice Address - Fax:480-745-3548
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60339118207L00000X, 207LP2900X
AZ66016207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine