1639347446 NPI number — DONALD L. MULDER, P.A.

Table of content: (NPI 1639347446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639347446 NPI number — DONALD L. MULDER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DONALD L. MULDER, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639347446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 FLOURNOY RD STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALICE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78332-4088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-668-0618
Provider Business Mailing Address Fax Number:
361-668-9677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 FLOURNOY RD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALICE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78332-4088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-668-0618
Provider Business Practice Location Address Fax Number:
361-668-9677
Provider Enumeration Date:
02/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MULDER
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
361-668-0618

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  J6182 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 123994903 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: U27S . This is a "BLUE CROSS BLUE SHIELD NU" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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