Provider Demographics
NPI:1780398776
Name:MULLIS, CHASE DANIEL
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:DANIEL
Last Name:MULLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51ST MEDICAL GROUP, 777 SONGTAN BOULVARD,
Mailing Address - Street 2:UNIT 2060
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:96278-3627
Mailing Address - Country:US
Mailing Address - Phone:315-784-3627
Mailing Address - Fax:
Practice Address - Street 1:51ST MEDICAL GROUP, 777 SONGTAN BOULVARD,
Practice Address - Street 2:UNIT 2060
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:96278-3627
Practice Address - Country:US
Practice Address - Phone:315-784-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician