Provider Demographics
NPI:1730526377
Name:BROOKS M MULLEN, MD PA
Entity type:Organization
Organization Name:BROOKS M MULLEN, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-372-0307
Mailing Address - Street 1:908 E COURT STREET
Mailing Address - Street 2:SUITE 2 & 4
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5850
Mailing Address - Country:US
Mailing Address - Phone:830-372-0307
Mailing Address - Fax:830-372-2153
Practice Address - Street 1:3349 S HIGHWAY 181
Practice Address - Street 2:BONNSTETTER BUILDING, SUITE A
Practice Address - City:KENEDY
Practice Address - State:TX
Practice Address - Zip Code:78119-5247
Practice Address - Country:US
Practice Address - Phone:830-372-0307
Practice Address - Fax:830-372-2153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKS M MULLEN, MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9859174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1578558938OtherNPI