Provider Demographics
NPI:1720408479
Name:MULLANE, MATTHEW TRAVIS (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:TRAVIS
Last Name:MULLANE
Suffix:
Gender:M
Credentials:MD MPH
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Mailing Address - Street 1:1116 NE ULYSSES DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3967
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:711 NE IRVING AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4738
Practice Address - Country:US
Practice Address - Phone:541-255-1530
Practice Address - Fax:541-219-5356
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0056225207Q00000X
WAMD61336231207Q00000X
ORMD189798207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine