Individual
JONATHAN D MOULDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1040 WISHARD BLVD, INDIANAPOLIS, IN 46202-2872
(317) 962-8893
(317) 962-6722
Mailing address
1040 WISHARD BLVD, INDIANAPOLIS, IN 46202-2872
(317) 962-8893
(317) 962-6722
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01075524A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201093200
—
IN
Enumeration date
05/24/2012
Last updated
06/23/2022
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