Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 28283 | NE |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 28283 | NE |
NPI | 1255774188 |
---|---|
Provider Name | Ian Mullikin |
First Address | Tripler Army Medical Center, HI 96859 |
Second Address | Tripler Army Medical Center, HI 96859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2013 |
Last Update Date | 23/09/2019 |