Basic Information
| Provider Information | |||||||||
| NPI: | 1265606974 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAVID A. MULLINS, MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1392 | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247401392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044251852 | ||||||||
| FaxNumber: | 3044313756 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 12TH STREET EXT | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247402329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044251852 | ||||||||
| FaxNumber: | 3044313756 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2008 | ||||||||
| LastUpdateDate: | 04/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | MULLINS | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | ARTHUR | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3044251852 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0127X | 19244 | WV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0048144000 | 05 | WV | MEDICAID |