Provider Demographics
NPI:1427303064
Name:MOULLET, PAUL ALFRED (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALFRED
Last Name:MOULLET
Suffix:
Gender:M
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:PSC 475 BOX 1
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96350-1200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:YOKOSUKA, INAOKACHO, 82
Practice Address - Street 2:238-0001
Practice Address - City:YOKOSUKA
Practice Address - State:JAPAN
Practice Address - Zip Code:96350
Practice Address - Country:JP
Practice Address - Phone:315-243-5534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO1633862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology