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NPI Code Detail

MEDICARE: DR. JEAN MULLEN M.C.

MEDICARE: DR. JEAN MULLEN M.C.
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
1208000000XPediatrics Physician30553AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1737603001OTHERAPIPA
2AZ0725160OTHERBLUE CROSS BLUE SHIELD
31Z3150OTHERHEALTHNET
4737603OTHERAZAHCCCS
500023340OTHERBANNER HEALTH PLAN
67376030OTHERDES

General Provider Information

NPI Number : 1174622914
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEAN MULLEN M.C.
Provider Business Mailing Address
First Line : 6285 S HIGLEY RD
Second Line :
City : GILBERT
State : AZ
Zip : 85298-4262
Country : US
Telephone Number : 480-480-4949
Fax Number : 480-460-5858
Provider Business Practice Location Address
First Line : 6285 S HIGLEY RD
Second Line :
City : GILBERT
State : AZ
Zip : 85298-4262
Country : US
Telephone Number : 480-480-4949
Fax Number : 480-460-5858
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 07/28/2020

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Directions to “ DR. JEAN MULLEN M.C.” Practice Location

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