Provider Demographics
NPI:1972893022
Name:TROWBRIDGE, MOLLY KATHERINE MORAN (MD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:KATHERINE MORAN
Last Name:TROWBRIDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:KATHERINE
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5012 S US HIGHWAY 75 STE 300
Mailing Address - Street 2:ATTN BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4589
Mailing Address - Country:US
Mailing Address - Phone:903-416-6025
Mailing Address - Fax:
Practice Address - Street 1:5012 S US HIGHWAY 75
Practice Address - Street 2:SUITE 225
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4636
Practice Address - Country:US
Practice Address - Phone:903-416-6025
Practice Address - Fax:903-416-6195
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ1317207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200550580AMedicaid
TX338002401Medicaid