Provider Demographics
NPI:1821080243
Name:MOLTER, JEFFREY E (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:E
Last Name:MOLTER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10335 PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-8814
Mailing Address - Country:US
Mailing Address - Phone:440-478-8448
Mailing Address - Fax:440-478-8448
Practice Address - Street 1:1709 MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1398
Practice Address - Country:US
Practice Address - Phone:419-429-0409
Practice Address - Fax:419-429-0410
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH248071367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2191855Medicaid
OH2191855Medicaid
OHMO8232613Medicare ID - Type Unspecified