Provider Demographics
NPI:1639375892
Name:MULLOY, MATTHEW RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RYAN
Last Name:MULLOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7777 FOREST LN STE B445
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6877
Mailing Address - Country:US
Mailing Address - Phone:972-566-6900
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LN STE B445
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6877
Practice Address - Country:US
Practice Address - Phone:972-566-6900
Practice Address - Fax:972-566-6993
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3197204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery