MEDICARE: AMY L MULLINS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	L1139	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346215381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY L MULLINS MD

Provider Business Mailing Address
First Line	:	PO BOX 5500
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75712-5500
Country	:	US
Telephone Number	:	903-324-6450
Fax Number	:	903-593-7852

Provider Business Practice Location Address
First Line	:	601 HWY 110 N
Second Line	:	BAY O
City	:	WHITEHOUSE
State	:	TX
Zip	:	75791-3037
Country	:	US
Telephone Number	:	903-839-2585
Fax Number	:	903-839-3165

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	04/04/2012

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