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General NPI Number Information
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NPI Number | 1629007208
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Entity Type | Individual
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Provider Name | GEORGE DALE MULDER M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 802 N RIVERSIDE RD. STE G50
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City | SAINT JOSEPH
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State | MO
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Zip | 64507-2553
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Country | US
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Telephone | 816-671-4888
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Fax | 816-671-4890
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Provider Business Mailing Address
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Address Line | 802 N. RIVERSIDE RD., STE. G50
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City | SAINT JOSEPH
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State | MO
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Zip | 64507-2553
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Country | US
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Telephone | 816-671-4888
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Fax | 816-671-4890
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | R7297
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | R7297
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License Number State | MO
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