Provider Demographics
NPI:1972506848
Name:MULLIS, DONALD L (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:MULLIS
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 1:111 VICTORIA RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4811
Mailing Address - Country:US
Mailing Address - Phone:828-252-7331
Mailing Address - Fax:828-250-9208
Practice Address - Street 1:111 VICTORIA RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4811
Practice Address - Country:US
Practice Address - Phone:828-252-7331
Practice Address - Fax:828-250-9208
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18812207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8961322Medicaid
NC209064BMedicare PIN
NC8961322Medicaid
NC5356960001Medicare NSC