Healthcare Provider Details

I. General information

NPI: 1164428843
Provider Name (Legal Business Name): DANIEL T. MCMULLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 MONTCLAIR RD STE 200
BIRMINGHAM AL
35213-1200
US

IV. Provider business mailing address

924 MONTCLAIR RD STE 200
BIRMINGHAM AL
35213-1200
US

V. Phone/Fax

Practice location:
  • Phone: 205-591-7999
  • Fax: 205-591-5051
Mailing address:
  • Phone: 205-591-7999
  • Fax: 205-591-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number15066
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: