Provider Demographics
NPI:1518003946
Name:MOELLER, JOHN ROGER (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROGER
Last Name:MOELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3250 LOMITA BLVD
Mailing Address - Street 2:# 204
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5007
Mailing Address - Country:US
Mailing Address - Phone:310-539-1022
Mailing Address - Fax:310-539-0736
Practice Address - Street 1:3250 LOMITA BLVD
Practice Address - Street 2:# 204
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5007
Practice Address - Country:US
Practice Address - Phone:310-539-1022
Practice Address - Fax:310-539-0736
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC322242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
13037OtherCOLLEGE HEALTH I PA
50071OtherUS BEHAVIORAL HEALTH
N02712OtherREGENCE BLUE SHIELD
00C322240OtherBLUE SHIELD
952905594OtherBLUE CROSS
A174012OtherVALUE OPTIONS
M0E1OtherTORRANCE HOSPITAL I PA
2343182OtherAETNA
50071OtherUS BEHAVIORAL HEALTH
A34852Medicare UPIN