Provider Demographics
NPI:1760428528
Name:MOLLER, DANIEL J JR (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:MOLLER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8001 YOUREE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2302
Mailing Address - Country:US
Mailing Address - Phone:318-212-3456
Mailing Address - Fax:318-212-3885
Practice Address - Street 1:8001 YOUREE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2302
Practice Address - Country:US
Practice Address - Phone:318-212-3456
Practice Address - Fax:318-212-3885
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA012335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1159859Medicaid
LA53097Medicare PIN
LA1159859Medicaid