Provider Demographics
NPI:1295739902
Name:MOLLOHAN, ERNEST LEE (DO)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:LEE
Last Name:MOLLOHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11631 HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:AL
Mailing Address - Zip Code:35648-3249
Mailing Address - Country:US
Mailing Address - Phone:256-229-6262
Mailing Address - Fax:256-229-6272
Practice Address - Street 1:11631 HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:AL
Practice Address - Zip Code:35648-3249
Practice Address - Country:US
Practice Address - Phone:256-229-6262
Practice Address - Fax:256-229-6272
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1326373861OtherGROUP NPI
G82899Medicare UPIN