Provider Demographics
NPI:1063486801
Name:MULLINS, RYAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DAVID
Last Name:MULLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10234 MARION PARK DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64137-1405
Mailing Address - Country:US
Mailing Address - Phone:816-201-3593
Mailing Address - Fax:
Practice Address - Street 1:10234 MARION PARK DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64137-1405
Practice Address - Country:US
Practice Address - Phone:816-201-3593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014013905207Q00000X
KS04-36926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTAX ID PLUS 041OtherTRICARE TRINITY CLINIC
TXTAX ID PLUS 088OtherTRICARE TRINITY CLINIC
TX123633OtherSUPERIOR HEALTH/CHIPS
TX8P9043OtherBCBS
TX7164442OtherAETNA
TX144234506Medicaid
TX752616977118OtherTRICARE
TX8P9043OtherBCBS
TX752616977118OtherTRICARE
TX8K1178Medicare Oscar/Certification
TXP00293253Medicare PIN