Provider Demographics
NPI:1508871252
Name:MOELLER, MARIE B (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:B
Last Name:MOELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LINCOLN CIR SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1862
Mailing Address - Country:US
Mailing Address - Phone:712-737-2000
Mailing Address - Fax:712-737-2115
Practice Address - Street 1:1000 LINCOLN CIR SE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1862
Practice Address - Country:US
Practice Address - Phone:712-737-2000
Practice Address - Fax:712-737-2115
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1508871252Medicaid
1003886367OtherGROUP
IA17161OtherAVERA
1962477992OtherGROUP
IA1508871252OtherWELLMARK
IA1508871252OtherSANFORD HEALTH PLAN
1003886367OtherGROUP
IAI7534001Medicare PIN