Provider Demographics
NPI:1912968512
Name:MULLIS, STEVEN L (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:L
Last Name:MULLIS
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 1969
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32402-1969
Mailing Address - Country:US
Mailing Address - Phone:850-785-0788
Mailing Address - Fax:850-785-1066
Practice Address - Street 1:114 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4605
Practice Address - Country:US
Practice Address - Phone:850-785-0788
Practice Address - Fax:850-785-1066
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0088963208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37832OtherBCBS FLORIDA
FLP00155017OtherRAILROAD MEDICARE
FL37832ZMedicare ID - Type Unspecified
FLP00155017OtherRAILROAD MEDICARE