Provider Demographics
NPI:1093862278
Name:MOLLOY, GERALD (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:MOLLOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:709 S HARBOR CITY BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1906
Mailing Address - Country:US
Mailing Address - Phone:321-499-4646
Mailing Address - Fax:321-270-9449
Practice Address - Street 1:709 S HARBOR CITY BLVD STE 110
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1906
Practice Address - Country:US
Practice Address - Phone:321-499-4646
Practice Address - Fax:321-270-9449
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME106745207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery