Provider Demographics
NPI:1689610867
Name:MULLIN, TIFFANY M (MD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:MULLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:21700 KINGSLAND BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2513
Mailing Address - Country:US
Mailing Address - Phone:281-398-8639
Mailing Address - Fax:281-398-5019
Practice Address - Street 1:21700 KINGSLAND BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2513
Practice Address - Country:US
Practice Address - Phone:281-398-8639
Practice Address - Fax:281-398-5019
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM3333207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183049901Medicaid
TXI62707Medicare UPIN
TX8G7868Medicare PIN