Provider Demographics
NPI:1639347446
Name:DONALD L. MULDER, P.A.
Entity Type:Organization
Organization Name:DONALD L. MULDER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:MULDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-668-0618
Mailing Address - Street 1:700 FLOURNOY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4088
Mailing Address - Country:US
Mailing Address - Phone:361-668-0618
Mailing Address - Fax:361-668-9677
Practice Address - Street 1:700 FLOURNOY RD STE 2
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4088
Practice Address - Country:US
Practice Address - Phone:361-668-0618
Practice Address - Fax:361-668-9677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6182208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123994903Medicaid
TXU27SOtherBLUE CROSS BLUE SHIELD NU
TX123994903Medicaid
TXG00459Medicare UPIN
TX=========OtherFEDERAL TAZ ID