Roy Allen Moll Jr.

Individual provider Active NPI Durable Medical Equipment & Medical Supplies · Deport, TX

NPI 1992448005 · NPPES record last updated Apr 16, 2022

Key facts

NPI
1992448005
Entity type
Individual (NPI type 1)
Primary specialty
Durable Medical Equipment & Medical Supplies 332B00000X
License
1002614 (TX)
Practice address
161 Main St
Deport, TX 75435-2560
Phone
(903) 209-8981
NPI assigned
Apr 16, 2022
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
1002614TXMDDurable Medical Equipment & Medical Supplies

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 1002614 TX Yes

Addresses

Primary practice location

161 Main St
Deport, TX 75435-2560

Mailing address

161 Main St
Deport, TX 75435-2560
Phone (903) 209-8981

Other identifiers

IdentifierTypeStateIssuer
1002614OtherTXTEXAS DME LICENSE

Electronic endpoints

TypeEndpointUseAffiliation
Direct Messaging Address rx@globaltech-pse.com Direct

Other providers in Deport, TX

All providers in Deport, TX · Durable Medical Equipment & Medical Supplies in Texas

Sources for this page

Verify at the official NPI Registry.