MEDICARE: DR. RYAN DAVID MULLINS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2014013905	MO
2	207Q00000X	Family Medicine Physician	04-36926	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TAX ID PLUS 041	OTHER	TX	TRICARE TRINITY CLINIC
2	TAX ID PLUS 088	OTHER	TX	TRICARE TRINITY CLINIC
3	123633	OTHER	TX	SUPERIOR HEALTH/CHIPS
4	8P9043	OTHER	TX	BCBS
5	7164442	OTHER	TX	AETNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	752616977118	OTHER	TX	TRICARE

General Provider Information

NPI Number	:	1063486801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN DAVID MULLINS MD

Provider Business Mailing Address
First Line	:	10234 MARION PARK DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64137-1405
Country	:	US
Telephone Number	:	816-201-3593
Fax Number	:

Provider Business Practice Location Address
First Line	:	10234 MARION PARK DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64137-1405
Country	:	US
Telephone Number	:	816-201-3593
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	06/13/2016

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Directions to “ DR. RYAN DAVID MULLINS MD” Practice Location

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