Provider Demographics
NPI:1720121684
Name:MOLLOY, ALLEN R (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:R
Last Name:MOLLOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 NW 56TH ST
Mailing Address - Street 2:206
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4479
Mailing Address - Country:US
Mailing Address - Phone:405-945-4740
Mailing Address - Fax:405-945-4751
Practice Address - Street 1:3330 NW 56TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4479
Practice Address - Country:US
Practice Address - Phone:405-945-4740
Practice Address - Fax:405-945-4751
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361634882085R0204X
OK223342085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK248722910OtherMEDICARE
OK249722912OtherMEDICARE
OKP00974065OtherMEDICARE RAILROAD (RALLC)
OK200106970AMedicaid
OKOKAAA0340 (MPI)Medicare PIN
OKOKAAA0334 (AI)Medicare PIN
OK249722912OtherMEDICARE