Provider Demographics
NPI:1487681185
Name:MCMULLIN, DOUGLAS B (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:B
Last Name:MCMULLIN
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1035 PLACER STREET
Mailing Address - Street 2:SHASTA COMMUNITY HEALTH CENTER / RESIDENCY
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-246-5710
Mailing Address - Fax:530-246-7838
Practice Address - Street 1:1035 PLACER STREET
Practice Address - Street 2:SHASTA COMMUNITY HEALTH CENTER / RESIDENCY
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-246-5710
Practice Address - Fax:530-246-7838
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG73745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G737450Medicaid
CA00G737450Medicaid
CA00G737450Medicare ID - Type Unspecified