Provider Demographics
NPI:1881006765
Name:MCMULLEN, DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:MCMULLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HARVEST MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:THE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78738-1472
Mailing Address - Country:US
Mailing Address - Phone:512-327-4711
Mailing Address - Fax:
Practice Address - Street 1:5 HARVEST MEADOW CT
Practice Address - Street 2:
Practice Address - City:THE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78738-1472
Practice Address - Country:US
Practice Address - Phone:512-327-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF 1810OtherTEXAS LISC
TXAM9600354OtherDEA
TXAM9600354OtherDEA