Provider Demographics
NPI:1073770640
Name:MUELLER, JEROME ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:ROBERT
Last Name:MUELLER
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:PO BOX 5594
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-0594
Mailing Address - Country:US
Mailing Address - Phone:951-658-1942
Mailing Address - Fax:951-658-9776
Practice Address - Street 1:371 N SAN JACINTO ST STE A
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3105
Practice Address - Country:US
Practice Address - Phone:951-658-1942
Practice Address - Fax:951-658-9776
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30868174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G308684Medicaid
CAA44578Medicare PIN