Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 01022049299 | VA |
Y | 2080P0203X | Pediatric Critical Care Doctor | 11710570-1204 | UT |
NPI | 1245654458 |
---|---|
Provider Name | Mason Paul Mcmullin |
First Address | Salt Lake City, UT 84108-1287 |
Second Address | Salt Lake City, UT 84108-1287 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2014 |
Last Update Date | 05/06/2020 |