MEDICARE: BRENT A MULLINS 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	207RH0003X	Hematology & Oncology Physician	18565	MS
2	207RH0003X	Hematology & Oncology Physician	18880	TN

General Provider Information

NPI Number	:	1558365205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT A MULLINS M.D.

Provider Business Mailing Address
First Line	:	281 BELLE MEADE LN
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38117-3028
Country	:	US
Telephone Number	:	901-734-0240
Fax Number	:

Provider Business Practice Location Address
First Line	:	281 BELLE MEADE LN
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38117-3028
Country	:	US
Telephone Number	:	901-734-0240
Fax Number	:

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	07/08/2022

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