Healthcare Provider Details

I. General information

NPI: 1356372981
Provider Name (Legal Business Name): ROBERT H MULFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 N MAIN ST
VERSAILLES IN
47042
US

IV. Provider business mailing address

PO BOX 189
MADISON IN
47250-0189
US

V. Phone/Fax

Practice location:
  • Phone: 812-689-5101
  • Fax: 812-265-0570
Mailing address:
  • Phone: 812-689-5101
  • Fax: 812-265-0570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01024903
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: