Individual
MICHAEL LOWELL MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
813 FOUNDERS PARK DR E, SPRINGDALE, AR 72762-6314
(479) 463-2440
(479) 463-2465
Mailing address
PO BOX 550, LOWELL, AR 72745-0550
(479) 463-7775
(479) 463-7187
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
E-4391
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
156776001
—
AR
05
—
200054700A
—
OK
01
—
5N139
AR BC/BS
AR
01
—
P00219962
RR MCR
AR
Enumeration date
06/23/2006
Last updated
11/06/2013
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