Provider Demographics
NPI:1194249110
Name:MOLLOY, JOSEPH E
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:E
Last Name:MOLLOY
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JOSEPH
Other - Middle Name:E
Other - Last Name:ARPAIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1210 NW 16TH ST
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2202
Practice Address - Country:US
Practice Address - Phone:208-452-8700
Practice Address - Fax:208-452-8701
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA57157363A00000X
ID1671360363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant