Provider Demographics
NPI:1053416677
Name:MOLINA, JOSE ERNESTO (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ERNESTO
Last Name:MOLINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:420 DELAWARE STREET SEMMC 292
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-3600
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE ST SE
Practice Address - Street 2:PWB THIRD FLOOR, CLINIC 3B
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0356
Practice Address - Country:US
Practice Address - Phone:612-625-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN20085208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN154095500Medicaid
MN2T100MOOtherBLUE CROSS BLUE SHIELD
MN079814OtherFAIRVIEW
MN18-22598OtherMEDICA CHOICE
IA0997775Medicaid
MN1009247OtherPREFERRED ONE
MNHP22192OtherHEALTH PARTNERS
MN768275OtherARAZ
MN101590OtherUCARE
MN18-00014OtherMEDICA PRIMARY
MN330002100Medicare ID - Type UnspecifiedRAILROAD
MN18-22598OtherMEDICA CHOICE