Healthcare Provider Details

I. General information

NPI: 1154367936
Provider Name (Legal Business Name): TERENCE R MUELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 S CANDY LN
COTTONWOOD AZ
86326-4158
US

IV. Provider business mailing address

PO BOX 7207
LOVELAND CO
80537-0207
US

V. Phone/Fax

Practice location:
  • Phone: 928-639-6580
  • Fax:
Mailing address:
  • Phone: 920-663-2742
  • Fax: 970-667-0847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number23971
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: