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1376534875

NPI Code Detail

MEDICARE: DR. CULLEN JOHN ARCHER MD

MEDICARE: DR. CULLEN JOHN ARCHER 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	207V00000X	Obstetrics & Gynecology Physician	37095	OK
2	207V00000X	Obstetrics & Gynecology Physician	7257858-1205	UT
3	207V00000X	Obstetrics & Gynecology Physician	L6769	TX

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	:	1376534875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CULLEN JOHN ARCHER MD

Provider Business Mailing Address
First Line	:	1215 CHAPEL HILL DR
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-3322
Country	:	US
Telephone Number	:	435-830-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 MATLOCK RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-2908
Country	:	US
Telephone Number	:	682-509-6200
Fax Number	:

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/27/2022

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Directions to “ DR. CULLEN JOHN ARCHER MD” Practice Location

Language	Start Address	Practice Location

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