Provider Demographics
NPI:1265675607
Name:MOLL, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MOLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7232-DEPT 118
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46207-7232
Mailing Address - Country:US
Mailing Address - Phone:317-614-9850
Mailing Address - Fax:800-731-0751
Practice Address - Street 1:4725 STATESMEN DR
Practice Address - Street 2:STE C-D
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-5644
Practice Address - Country:US
Practice Address - Phone:317-577-4200
Practice Address - Fax:317-614-9655
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01072203A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology