Provider Demographics
NPI:1356372981
Name:MULFORD, ROBERT H (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:MULFORD
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:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-0189
Mailing Address - Country:US
Mailing Address - Phone:812-689-5101
Mailing Address - Fax:812-265-0570
Practice Address - Street 1:128 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:IN
Practice Address - Zip Code:47042
Practice Address - Country:US
Practice Address - Phone:812-689-5101
Practice Address - Fax:812-265-0570
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN419687POtherSIHO
IN000000042197OtherANTHEM BCBS
080137666OtherMEDICARE RAILROAD
5845042OtherAETNA
IN701910LMedicare ID - Type Unspecified
IN701910LMedicare PIN
080137666OtherMEDICARE RAILROAD
IN419687POtherSIHO