Provider Demographics
NPI:1972535805
Name:MULLINS, JACKIE A (MD)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:A
Last Name:MULLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3337 PLAINVIEW ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1988
Mailing Address - Country:US
Mailing Address - Phone:713-941-6083
Mailing Address - Fax:713-941-6086
Practice Address - Street 1:3337 PLAINVIEW ST
Practice Address - Street 2:SUITE 8
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1988
Practice Address - Country:US
Practice Address - Phone:713-941-6083
Practice Address - Fax:713-941-6086
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG5415207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117605901Medicaid
TX85M400Medicare PIN
TXC19684Medicare UPIN