Healthcare Provider Details

I. General information

NPI: 1891706693
Provider Name (Legal Business Name): DAVID L MULLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 RIDGEWOOD RD
SPRINGFIELD VT
05156-3050
US

IV. Provider business mailing address

29 RIDGEWOOD RD
SPRINGFIELD VT
05156-3050
US

V. Phone/Fax

Practice location:
  • Phone: 802-885-6373
  • Fax: 802-885-6376
Mailing address:
  • Phone: 802-885-6373
  • Fax: 802-885-6376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number042-0009008
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number9254
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: