Provider Demographics
NPI:1134290984
Name:MOELLINGER, JUSTIN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:DAVID
Last Name:MOELLINGER
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 1:985 9TH AVE SW STE 507
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-7814
Mailing Address - Country:US
Mailing Address - Phone:205-481-7485
Mailing Address - Fax:205-481-7494
Practice Address - Street 1:985 9TH AVE SW STE 507
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-7814
Practice Address - Country:US
Practice Address - Phone:205-481-7485
Practice Address - Fax:205-481-7494
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23675208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009961362Medicaid
ALP002355578OtherRAILROAD MEDICARE
ALI06914Medicare UPIN
AL22494Medicare ID - Type Unspecified