Provider Demographics
NPI:1700830221
Name:SLOMAN-MOLL, ERIK R
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:R
Last Name:SLOMAN-MOLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:78045-6612
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:78045-6612
Practice Address - Country:US
Practice Address - Phone:956-795-8870
Practice Address - Fax:956-795-8384
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6333207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102575104Medicaid
TX152677402Medicaid
TX102575104Medicaid
TX00894TMedicare PIN