Provider Demographics
NPI:1003852245
Name:MOLLOY, DANIEL M (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:MOLLOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 12TH AVE N
Mailing Address - Street 2:STE 245W
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7506
Mailing Address - Country:US
Mailing Address - Phone:406-238-6010
Mailing Address - Fax:406-238-6022
Practice Address - Street 1:2900 12TH AVE N
Practice Address - Street 2:STE 245W
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7506
Practice Address - Country:US
Practice Address - Phone:406-238-6010
Practice Address - Fax:406-238-6022
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4105207V00000X, 207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT11490OtherBLUE CROSS OF MONTANA
MT46155203OtherWAUSAU
WY1057723Medicaid
MT0040716Medicaid
MT689502OtherPREFERRED ONE
MT0040716Medicaid
MT756163923Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MT011000749Medicare PIN