Provider Demographics
NPI:1275604027
Name:MOLDEN, GREGORY LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:LOUIS
Last Name:MOLDEN
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 1:2300 S GALVEZ ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-3102
Mailing Address - Country:US
Mailing Address - Phone:504-522-2230
Mailing Address - Fax:504-522-2248
Practice Address - Street 1:2300 S GALVEZ ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-3102
Practice Address - Country:US
Practice Address - Phone:504-522-2230
Practice Address - Fax:504-522-2248
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07197R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1363944Medicaid
LAB64053Medicare UPIN
LA5CA69Medicare PIN
LA1363944Medicaid