Healthcare Provider Details

I. General information

NPI: 1073583654
Provider Name (Legal Business Name): CHRISTIAN LEE MULLINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 TSCHACHE LN APT 206
BOZEMAN MT
59718-2070
US

IV. Provider business mailing address

4288 GHOLSON RD UNIT C
WACO TX
76705-1896
US

V. Phone/Fax

Practice location:
  • Phone: 209-743-7696
  • Fax:
Mailing address:
  • Phone: 209-743-7696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMED-PHYS-LIC-60652
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: