Provider Demographics
NPI:1639312846
Name:MOLES, BRYAN DOUGLAS (DO)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:DOUGLAS
Last Name:MOLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-0435
Mailing Address - Country:US
Mailing Address - Phone:412-977-1377
Mailing Address - Fax:412-246-9590
Practice Address - Street 1:225 W CENTER ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3447
Practice Address - Country:US
Practice Address - Phone:412-977-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014608207PE0004X
PAOS014609207PT0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services