Provider Demographics
NPI:1760442859
Name:MULLINS, JANET LEE (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LEE
Last Name:MULLINS
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 1:14436 S 25TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8047
Mailing Address - Country:US
Mailing Address - Phone:602-618-2461
Mailing Address - Fax:602-584-8802
Practice Address - Street 1:16611 S 40 ST
Practice Address - Street 2:SUITE 120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048
Practice Address - Country:US
Practice Address - Phone:480-706-4100
Practice Address - Fax:480-706-2600
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22089207Q00000X
NM86292207Q00000X
AZ22809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD22089Medicare ID - Type Unspecified
D35855Medicare UPIN