MEDICARE: DR. DONALD JAMES MCMULLIN D.O.

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	207R00000X	Internal Medicine Physician	DO R3A90	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110087272	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9072	OTHER	MO	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	208538	OTHER	MO	HEALTHLINK

General Provider Information

NPI Number	:	1518962570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD JAMES MCMULLIN D.O.

Provider Business Mailing Address
First Line	:	1050 W 10TH ST
Second Line	:	ATTN: EXECUTIVE DIRECTOR OF PHYSICIAN CLINICS
City	:	ROLLA
State	:	MO
Zip	:	65401-2905
Country	:	US
Telephone Number	:	573-364-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 W 10TH ST
Second Line	:
City	:	ROLLA
State	:	MO
Zip	:	65401
Country	:	US
Telephone Number	:	573-364-9000
Fax Number	:	573-202-2470

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	02/15/2026

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