Provider Demographics
NPI:1659380368
Name:MULLES, CORAZON (MD)
Entity Type:Individual
Prefix:
First Name:CORAZON
Middle Name:
Last Name:MULLES
Suffix:
Gender:F
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 70365
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36107-0365
Mailing Address - Country:US
Mailing Address - Phone:334-420-5001
Mailing Address - Fax:334-420-0146
Practice Address - Street 1:1000 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-4424
Practice Address - Country:US
Practice Address - Phone:334-420-5001
Practice Address - Fax:334-420-0146
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00020821207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51079046OtherBCBS
AL630900043Medicaid
AL630901043Medicaid
AL630903043Medicaid
AL4559602OtherPPN
AL51515589OtherBCBS
ALP00039998OtherMEDICARE RAILROAD
AL51515590OtherBCBS
AL51515595OtherBCBS
AL630902043Medicaid
AL4559602OtherPPN
AL630900043Medicaid