Provider Demographics
NPI:1194838573
Name:MULLEN, PATRICK WILLIAM (DPM)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:WILLIAM
Last Name:MULLEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6335 N FRESNO ST
Mailing Address - Street 2:#208
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5272
Mailing Address - Country:US
Mailing Address - Phone:559-435-0220
Mailing Address - Fax:559-435-9160
Practice Address - Street 1:6335 N FRESNO ST
Practice Address - Street 2:#208
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5272
Practice Address - Country:US
Practice Address - Phone:559-435-0220
Practice Address - Fax:559-435-9160
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3202213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE3202OtherCALIFORNIA LICENSE
CA328751600OtherDEPARTMENT OF LABOR
CA000E32020Medicaid
CA000E32020Medicaid
CA328751600OtherDEPARTMENT OF LABOR
CAT11575Medicare UPIN