Provider Demographics
NPI:1811913841
Name:MULFORD, JOHN J (NP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:MULFORD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5413 FRONTIER DR
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-2141
Mailing Address - Country:US
Mailing Address - Phone:940-465-4419
Mailing Address - Fax:
Practice Address - Street 1:2438 LILLIAN MILLER PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-2973
Practice Address - Country:US
Practice Address - Phone:940-382-9898
Practice Address - Fax:940-383-3815
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX589583363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ51061Medicare UPIN