Provider Demographics
NPI:1881816270
Name:MCMULLAN, JASON T (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:T
Last Name:MCMULLAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2830 VICTORY PKWY
Mailing Address - Street 2:ATTN LAURIE JOHNSTON, CENTRAL CREDENTIALING DEPARTMENT
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1785
Mailing Address - Country:US
Mailing Address - Phone:513-245-3667
Mailing Address - Fax:513-475-7259
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:ML0769
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2364
Practice Address - Country:US
Practice Address - Phone:513-558-8090
Practice Address - Fax:513-558-5791
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2010-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35.089363207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine