Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 26494 | AZ |
Y | 204F00000X | Transplant Surgeon | 54296 | CT |
N | 208200000X | Surgeon | 26494 | AZ |
N | 208600000X | Surgeon | 26494 | AZ |
N | 208200000X | Surgeon | 54296 | CT |
N | 208600000X | Surgeon | 54296 | CT |
NPI | 1487639449 |
---|---|
Provider Name | Dr. David C Mulligan |
First Address | New Haven, CT 06510-3206 |
Second Address | New Haven, CT 06510-3206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 18/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020038526 | RAILROAD MEDICARE (01) | AZ |
429755 | (05) | AZ |
86080015085259A462 | TRIWEST (01) | AZ |
C71201 | (02) |