Individual
MARK J.R. MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1400 MERCY DR., MUSKEGON, MI 49444-1878
(231) 733-1326
(231) 733-5212
Mailing address
1400 MERCY DR., MUSKEGON, MI 49444-1878
(231) 733-1326
(231) 733-5212
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
4301075708
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4238876
—
MI
01
—
4301075708
STATE LICENSE
MI
Enumeration date
04/10/2006
Last updated
11/01/2012
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