Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 283 | NM |
Y | 222Z00000X | Podiatrist | 283 | NM |
NPI | 1033105812 |
---|---|
Provider Name | Robert B Mullan |
First Address | Las Cruces, NM 88001-6018 |
Second Address | Las Cruces, NM 88011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 25/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47183829 | (05) | NM |
74864 | PRESBYTERIAN (01) | NM |
NM015A04 | BC/BS (01) | NM |
P00062140 | RR MEDICARE (01) | NM |
U69962 | (02) |