Provider Demographics
NPI:1811060080
Name:BROOKS M MULLEN MD PA
Entity type:Organization
Organization Name:BROOKS M MULLEN MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-372-0307
Mailing Address - Street 1:515 E COURT ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5750
Mailing Address - Country:US
Mailing Address - Phone:830-372-0307
Mailing Address - Fax:830-372-2153
Practice Address - Street 1:515 E COURT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5750
Practice Address - Country:US
Practice Address - Phone:830-372-0307
Practice Address - Fax:830-372-2153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9859207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1578558938OtherNPI