Provider Demographics
NPI:1902833767
Name:MULL, JEFFREY C (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:MULL
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 1:6607 SW WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-2608
Mailing Address - Country:US
Mailing Address - Phone:541-929-4440
Mailing Address - Fax:541-737-4530
Practice Address - Street 1:OREGON STATE UNIVERSITY STUDENT HEALTH SERVICES
Practice Address - Street 2:PLAGEMAN 201
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331
Practice Address - Country:US
Practice Address - Phone:541-737-3106
Practice Address - Fax:541-737-4530
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13544207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORE79832Medicare UPIN