Healthcare Provider Details

I. General information

NPI: 1063674802
Provider Name (Legal Business Name): JAMES HUGH MULLINS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W 11TH ST
PANAMA CITY FL
32401-2042
US

IV. Provider business mailing address

1010 W 11TH ST
PANAMA CITY FL
32401-2042
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-3622
  • Fax: 850-763-6175
Mailing address:
  • Phone: 850-763-3622
  • Fax: 850-763-6175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5098
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: