1922237676 NPI number — BARON T MULLIS MD

Table of content: BARON T MULLIS MD (NPI 1922237676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922237676 NPI number — BARON T MULLIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLIS
Provider First Name:
BARON
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1922237676
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 BOATNER ROAD, SUITE 114
Provider Second Line Business Mailing Address:
EMERGENCY MEDICINE DEPT
Provider Business Mailing Address City Name:
EGLIN AFB
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-883-8227
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 BOATNER ROAD, SUITE 114
Provider Second Line Business Practice Location Address:
EMERGENCY MEDICINE DEPT
Provider Business Practice Location Address City Name:
EGLIN AFB
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-883-8227
Provider Business Practice Location Address Fax Number:
850-883-8133
Provider Enumeration Date:
07/02/2009

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:  LL31970 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: ME113789 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: 75051 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 101489400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com