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NPI Code Detail

MEDICARE: DR. ERIC MULLEN M.D.

MEDICARE:  DR. ERIC  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
12085R0001XRadiation Oncology PhysicianMD25020OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MD25020OTHEROROREGON STATE LICENSE

General Provider Information

NPI Number : 1164481321
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIC MULLEN M.D.
Provider Business Mailing Address
First Line : PO BOX 8509
Second Line :
City : MEDFORD
State : OR
Zip : 97501-5009
Country : US
Telephone Number : 541-772-0023
Fax Number :
Provider Business Practice Location Address
First Line : 1111 CRATER LAKE AVE
Second Line :
City : MEDFORD
State : OR
Zip : 97504-6241
Country : US
Telephone Number : 541-732-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2006
Last Update Date : 08/05/2010

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Directions to “ DR. ERIC MULLEN M.D.” Practice Location

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