1902833767 NPI number — DR. JEFFREY C. MULL M.D.

Table of content: DR. JEFFREY C. MULL M.D. (NPI 1902833767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902833767 NPI number — DR. JEFFREY C. MULL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULL
Provider First Name:
JEFFREY
Provider Middle Name:
C.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1902833767
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6607 SW WINDING WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORVALLIS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97333-2608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-929-4440
Provider Business Mailing Address Fax Number:
541-737-4530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
OREGON STATE UNIVERSITY STUDENT HEALTH SERVICES
Provider Second Line Business Practice Location Address:
PLAGEMAN 201
Provider Business Practice Location Address City Name:
CORVALLIS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-737-3106
Provider Business Practice Location Address Fax Number:
541-737-4530
Provider Enumeration Date:
06/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  MD13544 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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