Provider Demographics
NPI:1518149491
Name:ERIK SLOMAN-MOLL, P.A.
Entity Type:Organization
Organization Name:ERIK SLOMAN-MOLL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:R
Authorized Official - Last Name:SLOMAN-MOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:956-794-8870
Mailing Address - Street 1:10410 MEDICAL LOOP UNIT 4B
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6672
Mailing Address - Country:US
Mailing Address - Phone:956-794-8870
Mailing Address - Fax:956-795-8384
Practice Address - Street 1:10410 MEDICAL LOOP UNIT 4B
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6672
Practice Address - Country:US
Practice Address - Phone:956-794-8870
Practice Address - Fax:956-795-8384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6333174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102575104Medicaid
TX193200000XMedicaid
TX237600000XMedicaid
TX152677402Medicaid
TX237600000XMedicaid