Individual
LARRY DWAYNE MULLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
405 E EXCELSIOR AVE, VINITA, OK 74301-4226
(918) 325-7005
Mailing address
PO BOX 712, AFTON, OK 74331-0712
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/08/2021
Last updated
09/14/2021
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