Provider Demographics
NPI:1285867473
Name:MOLINA, WILSON R JR (MD)
Entity Type:Individual
Prefix:
First Name:WILSON
Middle Name:R
Last Name:MOLINA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:3901 RAINBOW BLVD # MS 3016
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8500
Mailing Address - Country:US
Mailing Address - Phone:913-588-6146
Mailing Address - Fax:913-588-7625
Practice Address - Street 1:3901 RAINBOW BLVD # MS 3016
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-6146
Practice Address - Fax:913-588-7625
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2018031838208800000X
CO48148208800000X
KS04-41363208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology