DR. CASEY MULLEN, M.D. - NPI NUMBER 1104184993

Summary

Provider Name: DR. CASEY MULLEN, M.D.

NPI Number: 1104184993

Clasification: Student in an Organized Health Care Education/Training Program (390200000X)

Address:
4801 ALBERTA AVE
EL PASO, TX
ZIP 79905

Phone Number: (915) 545-7333



Detailed Information

DR. Casey Mullen, M.D. is a student in an organized health care education/training program in El Paso, TX. The provider is an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. The assigned NPI number for this provider is 1104184993 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business address is:

4801 ALBERTA AVE
EL PASO, TX
ZIP 79905-707
Phone: (915) 545-7333
Fax: (915) 545-7338

The enumeration date for this NPI number is 4/30/2012 and was last updated on 4/30/2012.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 390200000X Student in an Organized Health Care Education/Training Program Yes

NPI Record

No. Field Name Field Value
1 NPI 1104184993
2 Entity Type Code 1
3 Provider Last Name Legal Name MULLEN
4 Provider First Name CASEY
5 Provider Name Prefix Text DR.
6 Provider Credential Text M.D.
7 Provider First Line Business Practice Location Address 4801 ALBERTA AVE
8 Provider Business Practice Location Address City Name EL PASO
9 Provider Business Practice Location Address State Name TX
10 Provider Business Practice Location Address Postal Code 799052707
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 9155457333
13 Provider Business Practice Location Address Fax Number 9155457338
14 Provider Enumeration Date 4/30/2012
15 Last Update Date 4/30/2012
16 Provider Gender Code F
17 Healthcare Provider Taxonomy Code 1 390200000X
18 Healthcare Provider Primary Taxonomy Switch 1 Y
19 Is Sole Proprietor Y

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This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.