Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | N3197 | TX |
NPI | 1639375892 |
---|---|
Provider Name | Dr. Matthew Ryan Mulloy |
First Address | Dallas, TX 75230-6877 |
Second Address | Dallas, TX 75230-6877 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2007 |
Last Update Date | 26/05/2016 |