Provider Demographics
NPI:1528179256
Name:MULLINAX, VAL G (DPM)
Entity Type:Individual
Prefix:
First Name:VAL
Middle Name:G
Last Name:MULLINAX
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 N 1120 W # 6
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1045
Mailing Address - Country:US
Mailing Address - Phone:801-374-3010
Mailing Address - Fax:801-377-2426
Practice Address - Street 1:1928 N 1120 W # 6
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1045
Practice Address - Country:US
Practice Address - Phone:801-374-3010
Practice Address - Fax:801-377-2426
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT268974-0501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT47874OtherPEHP
UT480026356OtherRAILROAD MEDICARE
UT107711OtherDESERET MUTUAL HEALTH PLA
UT107008174101OtherSELECT HEALTH PLANS
UT27-00074OtherUNITED HEALTHCARE
UTQM0000070418OtherALTIUS HEALTHPLANS
UT107008174101OtherSELECT HEALTH PLANS
UT480026356OtherRAILROAD MEDICARE
UT27-00074OtherUNITED HEALTHCARE