Healthcare Provider Details

I. General information

NPI: 1285641027
Provider Name (Legal Business Name): DOUGLAS N. MCMULLEN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 W NORTH LOOP BLVD
AUSTIN TX
78756-2326
US

IV. Provider business mailing address

2301 W NORTH LOOP BLVD
AUSTIN TX
78756-2326
US

V. Phone/Fax

Practice location:
  • Phone: 512-452-2506
  • Fax: 512-853-9685
Mailing address:
  • Phone: 512-452-2506
  • Fax: 512-853-9685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberF1810
License Number StateTX

VIII. Authorized Official

Name: DOUGLAS NELSON MCMULLEN
Title or Position: PRESIDENT
Credential: MD
Phone: 512-452-2506