Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 15868 | MA |
N | 213EG0000X | General Practice | 15868 | MA |
N | 1223G0001X | General Practice | 5233 | NE |
N | 213EG0000X | General Practice | 5233 | NE |
NPI | 1003812538 |
---|---|
Provider Name | Dr. Gregg Kent Mullens |
First Address | Greenfield, MA 01301-2436 |
Second Address | Greenfield, MA 01301-2436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
XO8195 | BLUE CROSS/BLUE SHIELD ID (01) | MA |