Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 3775 | KY |
NPI | 1639261639 |
---|---|
Provider Name | Dr. Merwyn Raynor Mullins |
First Address | Lexington, KY 40536-0297 |
Second Address | Lexington, KY 40536-0297 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60037751 | (05) | KY |