Provider Demographics
NPI:1750472502
Name:MULLICAN, THOMAS H (PA-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:MULLICAN
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1942 AL HIGHWAY 157
Mailing Address - Street 2:CULLMAN REGIONAL ORTHOPEDICS AND SPORTS MEDICINE, P.C.
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0609
Mailing Address - Country:US
Mailing Address - Phone:256-737-5115
Mailing Address - Fax:256-737-5003
Practice Address - Street 1:1942 AL HIGHWAY 157
Practice Address - Street 2:CULLMAN REGIONAL ORTHOPEDICS AND SPORTS MEDICINE, P.C.
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0609
Practice Address - Country:US
Practice Address - Phone:256-737-5115
Practice Address - Fax:256-737-5003
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-02-08
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Provider Licenses
StateLicense IDTaxonomies
ALT1616363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00368354OtherRAILROAD MEDICARE
ALP00368354OtherRAILROAD MEDICARE