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General NPI Number Information
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NPI Number | 1619173259
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Entity Type | Individual
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Provider Name | BRYAN JAMES MULLOOLY MD
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Gender | Male
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 11/23/2015
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Provider Practice Location Address
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Address Line | 4301 WEST MARKHAM STREET
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City | LITTLE ROCK
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State | AR
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Zip | 72207
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Country | US
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Telephone | 708-224-7323
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Fax |
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Provider Business Mailing Address
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Address Line | 6357 CATALINA AVENUE
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City | OAK FOREST
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State | IL
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Zip | 60452-1733
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Country | US
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Telephone | 708-224-7323
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036.126693
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | TP118
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | E-7613
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License Number State | AR
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