Provider Demographics
NPI:1386685758
Name:MULROONEY, JAMES PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:MULROONEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0556
Mailing Address - Country:US
Mailing Address - Phone:209-571-6622
Mailing Address - Fax:
Practice Address - Street 1:1524 MCHENRY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4500
Practice Address - Country:US
Practice Address - Phone:209-577-4444
Practice Address - Fax:209-527-2069
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC326642085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C326640Medicaid
CA00C326648Medicare PIN
CA00C326645Medicare PIN
CA00C326647Medicare PIN
CA00C3266410Medicare PIN
CA00C326640Medicaid
CA300024670Medicare PIN
CA00C3266413Medicare PIN
CA00C3266415Medicare PIN
CA00C326642Medicare PIN
CA00C326649Medicare PIN
CA00C326643Medicare PIN
CA00C326646Medicare PIN
CA00C3266412Medicare PIN
CA00C3266416Medicare PIN
CA00C326644Medicare PIN
CA00C3266411Medicare PIN
CA00C326640Medicare PIN
CA00C3266414Medicare PIN