Provider Demographics
NPI:1598772188
Name:NACOGDOCHES GASTROENTEROLOGY, P.A.
Entity Type:Organization
Organization Name:NACOGDOCHES GASTROENTEROLOGY, P.A.
Other - Org Name:MICHAEL E. MOLLOT, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-569-6449
Mailing Address - Street 1:1018 N MOUND ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4492
Mailing Address - Country:US
Mailing Address - Phone:936-569-6449
Mailing Address - Fax:936-569-2458
Practice Address - Street 1:1018 N MOUND ST
Practice Address - Street 2:SUITE 105
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4492
Practice Address - Country:US
Practice Address - Phone:936-569-6449
Practice Address - Fax:936-569-2458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3164174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty