Individual
CHARLES J. MCMULLIN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 FOXHEAD SHORES DR, LINN CREEK, MO 65052-2563
(573) 480-4721
Mailing address
300 FOXHEAD SHORES DR, LINN CREEK, MO 65052-2563
(573) 480-4721
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD117270
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205428204
—
MO
Enumeration date
08/31/2006
Last updated
06/21/2011
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