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General NPI Number Information
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NPI Number | 1699758136
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Entity Type | Individual
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Provider Name | SUSAN C MCMULLEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/29/2005
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 100 MUNICIPAL DR SUITE 300
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City | GUN BARREL CITY
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State | TX
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Zip | 75156-3702
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Country | US
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Telephone | 903-713-1571
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Fax |
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Provider Business Mailing Address
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Address Line | 904 S BECKHAM AVE
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City | TYLER
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State | TX
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Zip | 75701-1906
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Country | US
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Telephone | 903-596-3588
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25065
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License Number State | AZ
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