Provider Demographics
NPI:1356503858
Name:CRAIG M MCMULLEN MD PA
Entity Type:Organization
Organization Name:CRAIG M MCMULLEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:M
Authorized Official - Last Name:MMCMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-591-0091
Mailing Address - Street 1:233 HURST ST
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-4321
Mailing Address - Country:US
Mailing Address - Phone:936-591-0091
Mailing Address - Fax:
Practice Address - Street 1:233 HURST ST
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935-4321
Practice Address - Country:US
Practice Address - Phone:936-591-0091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6742207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty