Healthcare Provider Details

I. General information

NPI: 1710321138
Provider Name (Legal Business Name): PATRICK R. MULLIGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S SAN MATEO DR
SAN MATEO CA
94401-3805
US

IV. Provider business mailing address

PO BOX 6102
NOVATO CA
94948-6102
US

V. Phone/Fax

Practice location:
  • Phone: 650-696-4515
  • Fax: 650-696-4626
Mailing address:
  • Phone: 415-884-3404
  • Fax: 415-883-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA134461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: