Provider Demographics
NPI:1669590543
Name:MOLITOR, MARK STEVEN JR (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:MOLITOR
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3200 E CAMELBACK RD
Mailing Address - Street 2:STE 250
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2327
Mailing Address - Country:US
Mailing Address - Phone:602-933-1814
Mailing Address - Fax:
Practice Address - Street 1:1920 E CAMBRIDGE AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-1459
Practice Address - Country:US
Practice Address - Phone:602-254-5561
Practice Address - Fax:602-254-2185
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2018-03-23
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Provider Licenses
StateLicense IDTaxonomies
MI43010881112086S0102X, 2086S0120X
AZ475582086S0102X, 2086S0127X, 2086S0120X, 2086S0127X
UT7947793-12052086S0120X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery