Provider Demographics
NPI:1164415782
Name:ROBERT MULLAN DPM INC
Entity Type:Organization
Organization Name:ROBERT MULLAN DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:MULLAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:575-522-2271
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 1:1400 EL PASEO RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-6018
Practice Address - Country:US
Practice Address - Phone:575-522-2776
Practice Address - Fax:575-522-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMDA5269OtherRR MEDICARE
NMNM015A04OtherBCBS OF NM
5028900001Medicare NSC
NM900521053Medicare ID - Type Unspecified