Healthcare Provider Details

I. General information

NPI: 1376534875
Provider Name (Legal Business Name): CULLEN JOHN ARCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 MATLOCK RD
ARLINGTON TX
76015-2908
US

IV. Provider business mailing address

1215 CHAPEL HILL DR
MANSFIELD TX
76063-3322
US

V. Phone/Fax

Practice location:
  • Phone: 682-509-6200
  • Fax:
Mailing address:
  • Phone: 435-830-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number37095
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number7257858-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberL6769
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: