Provider Demographics
NPI:1891760237
Name:MULLEN, DAVID ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:MULLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:30 N ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-1210
Mailing Address - Country:US
Mailing Address - Phone:573-358-3343
Mailing Address - Fax:573-358-5458
Practice Address - Street 1:30 N ALLEN ST
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-1210
Practice Address - Country:US
Practice Address - Phone:573-358-3343
Practice Address - Fax:573-358-5458
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO325136OtherHARMONY HEALTH PLAN
MO242084929Medicaid
MO4393019OtherAETNA
MOA10298OtherMERCY HEALTH PLAN
MO080123004OtherRAILROAD MEDICARE
MO700678OtherMERCY CARE PLUS
MO0130012OtherUNITED HEALTH CARE
MO101523OtherHEALTHLINK, INC.
MO20351OtherBC.BS OF MO
MO367V40311OtherGROUP HEALTH PLAN
MO431815767OtherCMR
MO13015V21878OtherHEALTHCARE USA
MO431815767OtherGREAT WEST LIFE INS