Provider Demographics
NPI:1033105812
Name:MULLAN, ROBERT B (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:MULLAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 EL PASEO RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-6018
Mailing Address - Country:US
Mailing Address - Phone:575-522-2776
Mailing Address - Fax:575-522-2271
Practice Address - Street 1:2445 S TELSHORE BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:575-522-2776
Practice Address - Fax:575-522-2271
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM283213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM015A04OtherBC/BS
NM47183829Medicaid
NM74864OtherPRESBYTERIAN
NMP00062140OtherRR MEDICARE
NM47183829Medicaid
NM74864OtherPRESBYTERIAN
NMP00062140OtherRR MEDICARE