Provider Demographics
NPI:1265065718
Name:MULHERN, THOMAS CAMPBELL (PA-C)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CAMPBELL
Last Name:MULHERN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SIMMS ST UNIT 536
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-5127
Mailing Address - Country:US
Mailing Address - Phone:708-466-9741
Mailing Address - Fax:
Practice Address - Street 1:730 SIMMS ST UNIT 536
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5127
Practice Address - Country:US
Practice Address - Phone:708-466-9741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA59963363A00000X
COPA.0008015363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant