Provider Demographics
NPI:1255384871
Name:MOLLEN, MARTIN D (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:D
Last Name:MOLLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16100 N 71ST. STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTSDALE,
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2225
Mailing Address - Country:US
Mailing Address - Phone:480-656-0016
Mailing Address - Fax:480-634-1723
Practice Address - Street 1:16100 N 71ST. STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE,
Practice Address - State:AZ
Practice Address - Zip Code:85254-2225
Practice Address - Country:US
Practice Address - Phone:480-656-0016
Practice Address - Fax:480-634-1723
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ8864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
X11WCHWQ04Medicare ID - Type Unspecified
D00001Medicare UPIN