1730526377 NPI number — BROOKS M MULLEN, MD PA

Table of content: (NPI 1730526377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730526377 NPI number — BROOKS M MULLEN, MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKS M MULLEN, MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730526377
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
908 E COURT STREET
Provider Second Line Business Mailing Address:
SUITE 2 & 4
Provider Business Mailing Address City Name:
SEGUIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78155-5850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-372-0307
Provider Business Mailing Address Fax Number:
830-372-2153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3349 S HIGHWAY 181
Provider Second Line Business Practice Location Address:
BONNSTETTER BUILDING, SUITE A
Provider Business Practice Location Address City Name:
KENEDY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78119-5247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-372-0307
Provider Business Practice Location Address Fax Number:
830-372-2153
Provider Enumeration Date:
05/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MULLEN
Authorized Official First Name:
BROOKS
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
830-372-0307

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  F9859 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1578558938 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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