MEDICARE: PAUL E MULLEN M.D.

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	207RC0000X	Cardiovascular Disease Physician	12449	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114977451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL E MULLEN M.D.

Provider Business Mailing Address
First Line	:	1391 BROAD AVE
Second Line	:	SUITE 340
City	:	GULFPORT
State	:	MS
Zip	:	39501-2419
Country	:	US
Telephone Number	:	228-863-8868
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720A MEDICAL PARK DR
Second Line	:	SUITE 340
City	:	BILOXI
State	:	MS
Zip	:	39532-2129
Country	:	US
Telephone Number	:	228-392-7429
Fax Number	:	228-396-3830

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	09/15/2016

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Directions to “ PAUL E MULLEN M.D.” Practice Location

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