Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME16284 | FL |
Y | 208600000X | Surgeon | ME16284 | FL |
NPI | 1003832197 |
---|---|
Provider Name | Dr. Walter R Mullin |
First Address | Miami, FL 33156 |
Second Address | Miami, FL 33156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D60104 | (02) |