MEDICARE: BRIAN T MULBERRY 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	207Q00000X	Family Medicine Physician	38683	KY

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
2	0000000337046	OTHER	KY	ANTHEM
3	79578580	OTHER	KY	AETNA

General Provider Information

NPI Number	:	1831145887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN T MULBERRY MD

Provider Business Mailing Address
First Line	:	1210 KY HIGHWAY 36 E
Second Line	:	SUITE 2 C
City	:	CYNTHIANA
State	:	KY
Zip	:	41031-7490
Country	:	US
Telephone Number	:	859-234-6000
Fax Number	:	859-234-6011

Provider Business Practice Location Address
First Line	:	1210 KY HIGHWAY 36 E
Second Line	:	SUITE 2 C
City	:	CYNTHIANA
State	:	KY
Zip	:	41031-7490
Country	:	US
Telephone Number	:	859-234-6000
Fax Number	:	859-234-6011

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	09/27/2012

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Directions to “ BRIAN T MULBERRY MD” Practice Location

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