Basic Information
| Provider Information | |||||||||
| NPI: | 1417337676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOLESKI | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | WALTER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 453 AMBER LAKE CT | ||||||||
| Address2: | |||||||||
| City: | IMPERIAL | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630523114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142584812 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1015 BOWLES AVE | ||||||||
| Address2: | |||||||||
| City: | FENTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6364962000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2015 | ||||||||
| LastUpdateDate: | 11/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 2017023056 | MO | N | Allopathic & Osteopathic Physicians | Hospitalist | 207QA0505X | 2017023056 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
No ID Information.