Provider Demographics
NPI:1063449676
Name:JAMES, MOLLIE MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:MOLLIE
Middle Name:MARIE
Last Name:JAMES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 SAINT JOHNS BLVD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1563
Mailing Address - Country:US
Mailing Address - Phone:417-781-2727
Mailing Address - Fax:417-781-5845
Practice Address - Street 1:2817 SAINT JOHNS BLVD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1563
Practice Address - Country:US
Practice Address - Phone:417-781-2727
Practice Address - Fax:417-781-5845
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012018322207RC0200X, 2086S0102X, 208600000X
KS05357202086S0102X
IA3590208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1063449676Medicaid
KS200974630AMedicaid
MO1063449676Medicaid