Provider Demographics
NPI:1295554731
Name:MOLL, SAMUEL JAMES (PA)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JAMES
Last Name:MOLL
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:9663 CANVASBACK DR
Mailing Address - Street 2:
Mailing Address - City:MASCOUTAH
Mailing Address - State:IL
Mailing Address - Zip Code:62258-2763
Mailing Address - Country:US
Mailing Address - Phone:618-401-9856
Mailing Address - Fax:
Practice Address - Street 1:2325 DOUGHERTY FERRY RD STE 100
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-3356
Practice Address - Country:US
Practice Address - Phone:618-401-9856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant