Daniel W Moullet, MD
Individual provider Active NPI Family Medicine Physician · Ronan, MT
NPI 1790773802 · NPPES record last updated Sep 13, 2013
Key facts
- NPI
- 1790773802
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD00034152 (WA)
- Practice address
- 107 6TH Ave SW
Ronan, MT 59864-2634 - Phone
- (406) 676-4441
- Fax
- (406) 676-0835
- NPI assigned
- Oct 12, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Okanogan County Public Hospital Dist No 4 | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD00034152 | WA | Yes |
Addresses
Primary practice location
107 6TH Ave SW
Ronan, MT 59864-2634
Mailing address
1200 E Columbia Ave
Colville, WA 99114-3354
Phone (509) 684-3701
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 114507 | Other | L & I | |
| 8208357 | Medicaid | WA |
Other providers in Ronan, MT
- Mission Mountain Home Care LLC
- Mission Valley Eye Center, Inc.
- Mission Valley Wellness, PLLC
- Char-El Teresa Montana
- James Michael Moore
- Mountain View Care Center, Inc
- Kristin A. Murphy
- Justin C Newton
- Mary Katherine Nissen
- Alexander J. Nutt
All providers in Ronan, MT · Family Medicine Physician in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.