Provider Demographics
NPI:1205926383
Name:MOLINA, JOHN WARD (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WARD
Last Name:MOLINA
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 1:8625 S AVENIDA DEL YAQUI
Mailing Address - Street 2:
Mailing Address - City:GUADALUPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2504
Mailing Address - Country:US
Mailing Address - Phone:480-777-2263
Mailing Address - Fax:480-777-2264
Practice Address - Street 1:8625 S AVENIDA DEL YAQUI
Practice Address - Street 2:
Practice Address - City:GUADALUPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-2504
Practice Address - Country:US
Practice Address - Phone:480-777-2263
Practice Address - Fax:480-777-2264
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20789207V00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ402438Medicaid
AZ28805Medicare ID - Type Unspecified
AZ402438Medicaid