Healthcare Provider Details

I. General information

NPI: 1700998473
Provider Name (Legal Business Name): DAVID ARTHUR MULLINS MD RVT FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 12TH ST EXTENSION
PRINCETON WV
24740
US

IV. Provider business mailing address

118 12TH STREET EXT
PRINCETON WV
24740-2352
US

V. Phone/Fax

Practice location:
  • Phone: 304-425-1852
  • Fax: 304-431-3756
Mailing address:
  • Phone: 304-431-5168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number19244
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number19244
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0101239029
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number19244
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: