Provider Demographics
NPI:1295792422
Name:MULLINS, ROBERT DUANE (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DUANE
Last Name:MULLINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8806 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-1940
Mailing Address - Country:US
Mailing Address - Phone:740-574-8893
Mailing Address - Fax:
Practice Address - Street 1:8806 GREEN ST
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-1940
Practice Address - Country:US
Practice Address - Phone:740-574-8893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008202207P00000X
KY03030207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000543723OtherBCBS
KY50016930OtherPASSPORT
WV3810010698Medicaid
WV1072427OtherBRICKSTREET
OH2487447Medicaid
OH2487447OtherOH MEDICAID MOLINA
KY64085970Medicaid
OH2487447OtherOH MEDICAID MOLINA
KY0931052Medicare PIN
I04950Medicare UPIN