Provider Demographics
NPI:1093716391
Name:MOLLAND, JOHN ROBERT (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:MOLLAND
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 1:601 N TOM GREEN AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4567
Mailing Address - Country:US
Mailing Address - Phone:432-334-7888
Mailing Address - Fax:432-334-9949
Practice Address - Street 1:601 N TOM GREEN AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4567
Practice Address - Country:US
Practice Address - Phone:432-334-7888
Practice Address - Fax:432-334-9949
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9219207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T69HOtherBLUE CROSS BLUE SHIELD
TX8A9681Medicare ID - Type UnspecifiedMEDICARE
TX00T69HOtherBLUE CROSS BLUE SHIELD