Healthcare Provider Details

I. General information

NPI: 1679832471
Provider Name (Legal Business Name): STEPHEN MCMULLAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 07/24/2021
Certification Date: 07/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4389 BEAUFORT ROAD
CHERRY POINT NC
28533
US

IV. Provider business mailing address

4500 SAN PABLO RD S
JACKSONVILLE FL
32224-1865
US

V. Phone/Fax

Practice location:
  • Phone: 252-466-0266
  • Fax:
Mailing address:
  • Phone: 904-953-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number70666
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME141938
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: