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General NPI Number Information
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NPI Number | 1689873796
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Entity Type | Individual
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Provider Name | RAY EDWARD MCMULLEN JR. PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 12/18/2008
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Provider Practice Location Address
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Address Line | 1120 PIKE ST SCI-SMITHFIELD
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City | HUNTINGDON
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State | PA
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Zip | 16652-1117
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Country | US
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Telephone | 814-643-9342
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Fax |
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Provider Business Mailing Address
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Address Line | 53 JENNIFER DR
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City | MOUNT UNION
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State | PA
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Zip | 17066-9111
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Country | US
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Telephone | 814-542-9645
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA-000398-L
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License Number State | PA
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