Provider Demographics
NPI:1417932005
Name:MULHERN, PETER J (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:MULHERN
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:PO BOX 3130
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-3130
Mailing Address - Country:US
Mailing Address - Phone:352-751-1036
Mailing Address - Fax:352-750-4698
Practice Address - Street 1:8550 NE 138TH LN
Practice Address - Street 2:BUILDING 400, SUITE 101B
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8957
Practice Address - Country:US
Practice Address - Phone:352-751-1036
Practice Address - Fax:352-750-4698
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053517207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA06698867AMedicaid
GA20NCCCLMedicare PIN
GA06698867AMedicaid