Provider Demographics
NPI:1417248923
Name:MULLINS, JOHN EVERETT (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EVERETT
Last Name:MULLINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21110 MARKET RDG
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4984
Mailing Address - Country:US
Mailing Address - Phone:210-490-7334
Mailing Address - Fax:210-490-7335
Practice Address - Street 1:21110 MARKET RDG
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4984
Practice Address - Country:US
Practice Address - Phone:210-490-7334
Practice Address - Fax:210-490-7335
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP89532080S0010X, 208000000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics