Healthcare Provider Details

I. General information

NPI: 1053673202
Provider Name (Legal Business Name): THOMAS D MULLEN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 NW MYHRE RD
SILVERDALE WA
98383-7662
US

IV. Provider business mailing address

1900 NW MYHRE RD
SILVERDALE WA
98383-7662
US

V. Phone/Fax

Practice location:
  • Phone: 564-240-3100
  • Fax: 564-240-3198
Mailing address:
  • Phone: 564-240-3100
  • Fax: 564-240-3198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD.MD.60482538
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: