Basic Information
Provider Information
NPI: 1639147382
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MOLLS
FirstName: FRANK
MiddleName: ERNST
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3709 N CAMPBELL AVE STE 201
Address2:  
City: TUCSON
State: AZ
PostalCode: 857191563
CountryCode: US
TelephoneNumber: 5208382138
FaxNumber: 5208382260
Practice Location
Address1: 1238 W ORANGE GROVE RD STE 103
Address2:  
City: TUCSON
State: AZ
PostalCode: 857042950
CountryCode: US
TelephoneNumber: 5208383540
FaxNumber: 5203253526
Other Information
ProviderEnumerationDate: 03/09/2006
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X26576AZY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

ID Information
IDTypeStateIssuerDescription
44886205AZ MEDICAID


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