Provider Demographics
NPI:1750447215
Name:R. MOLLIE A. JOHN, M.D., APMC
Entity Type:Organization
Organization Name:R. MOLLIE A. JOHN, M.D., APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:R. MOLLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-387-1437
Mailing Address - Street 1:2701 BRIERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3048
Mailing Address - Country:US
Mailing Address - Phone:318-387-1437
Mailing Address - Fax:318-322-2685
Practice Address - Street 1:2701 BRIERFIELD DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3048
Practice Address - Country:US
Practice Address - Phone:318-387-1437
Practice Address - Fax:318-322-2685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10383R204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1989258Medicaid
LAFU516Medicare ID - Type Unspecified
LAF86057Medicare UPIN