Provider Demographics
NPI:1891736435
Name:MULLEN, DANIEL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:MULLEN
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 1:4852 E BASELINE RD
Mailing Address - Street 2:STE 107
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4628
Mailing Address - Country:US
Mailing Address - Phone:480-834-7000
Mailing Address - Fax:480-834-7002
Practice Address - Street 1:4852 E BASELINE RD
Practice Address - Street 2:#C-107
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4627
Practice Address - Country:US
Practice Address - Phone:480-834-7000
Practice Address - Fax:480-834-7002
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30294207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ699522Medicaid
AZ3Z3972OtherHEALTHNET
AZ699522Medicaid
AZP00845782Medicare PIN
AZ3Z3972OtherHEALTHNET