Individual
TIMOTHY JAY MOLLOTTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
358 N MAIN ST, COLVILLE, WA 99114-2310
(509) 684-1440
Mailing address
PO BOX 808, CHEWELAH, WA 99109-0808
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.PA.61363297
WA
363AM0700X
Medical Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/31/2021
Last updated
04/23/2024
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