Provider Demographics
NPI:1043206733
Name:MCMULLEN, DEIRDRE (MD)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3281 ROCKY CREEK DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4750
Mailing Address - Country:US
Mailing Address - Phone:281-206-0068
Mailing Address - Fax:281-499-5045
Practice Address - Street 1:3281 ROCKY CREEK DR
Practice Address - Street 2:SUITE 500
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4750
Practice Address - Country:US
Practice Address - Phone:281-206-0068
Practice Address - Fax:281-499-5045
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H00249Medicare UPIN
H00249Medicare UPIN