Individual
JOHN MULLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1115 12TH AVE RD, NAMPA, ID 83686-5738
(208) 498-1080
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6522
(208) 955-6503
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
M5653
ID
207Q00000X
Family Medicine Physician
Primary
M-5653
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003816800
—
ID
Enumeration date
06/21/2006
Last updated
08/05/2013
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