Provider Demographics
NPI:1780752915
Name:MULDER, RICHARD DEAN (MD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DEAN
Last Name:MULDER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:121 SAXON AVE W PO BOX 76
Mailing Address - Street 2:
Mailing Address - City:IVANHOE
Mailing Address - State:MN
Mailing Address - Zip Code:56142-0076
Mailing Address - Country:US
Mailing Address - Phone:507-694-1232
Mailing Address - Fax:507-694-1171
Practice Address - Street 1:121 SAXON AVE W
Practice Address - Street 2:
Practice Address - City:IVANHOE
Practice Address - State:MN
Practice Address - Zip Code:56142-0076
Practice Address - Country:US
Practice Address - Phone:507-694-1232
Practice Address - Fax:507-694-1171
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN18873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND48832Medicare UPIN