Provider Demographics
NPI:1164775383
Name:MULLINS, CLIFFORD
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:MULLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CLIFF
Other - Middle Name:
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1106 N IRONWOOD PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1508
Mailing Address - Country:US
Mailing Address - Phone:918-289-3316
Mailing Address - Fax:
Practice Address - Street 1:1106 N IRONWOOD PL
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1508
Practice Address - Country:US
Practice Address - Phone:918-289-3316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter