Provider Demographics
NPI:1083254411
Name:MULLET, CALVIN THOMAS
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:THOMAS
Last Name:MULLET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23899 STATE HIGHWAY 74
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-6964
Mailing Address - Country:US
Mailing Address - Phone:405-253-3838
Mailing Address - Fax:
Practice Address - Street 1:23899 STATE HIGHWAY 74
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-6964
Practice Address - Country:US
Practice Address - Phone:405-253-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist