Healthcare Provider Details

I. General information

NPI: 1831417625
Provider Name (Legal Business Name): WILLIAM CASON MULLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 08/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 S PETERS ST UNIT 117
NEW ORLEANS LA
70130-1759
US

IV. Provider business mailing address

9049 W JUDGE PEREZ DR 353
CHALMETTE LA
70043-4514
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-4647
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number301398
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: