Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 017580 | LA |
NPI | 1104974641 |
---|---|
Provider Name | David H Mull |
First Address | Shreveport, LA 71103-3920 |
Second Address | Shreveport, LA 71103-3920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 07/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000039815 | (05) | AL |
0119079 | (05) | MS |
1810010 | UHC (01) | AL |
51039815 | BCBS OF AL (01) | AL |
5536685 | AETNA PROVIDER # (01) | AL |
B65309 | (02) | AL |
B65309 | HEALTHSPRINGS OF AL (01) | AL |