Individual
JERRY A MOLITOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
516 DELAWARE STREET SE, CLINIC 6A, UMP MEDICINE SPECIALTIES CLINIC, MINNEAPOLIS, MN 55455
(612) 884-0649
Mailing address
720 WASHINGTON AVE SE, UNIVERSITY OF MINNESOTA PHYSICIANS, MINNEAPOLIS, MN 55414
(612) 884-0649
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
MD00035031
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039583
LABOR & INDUSTRY
WA
01
—
6118MO
BLUE SHIELD
WA
01
—
660003069
RAILROAD MEDICARE
—
01
—
805452300
IDAHO MEDICAID
WA
05
—
8256877
—
WA
01
—
MD9155W
ALASKA MEDICAID
WA
01
—
US2338018
AETNA/USHC SPECIALIST
WA
Enumeration date
08/04/2006
Last updated
10/31/2012
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