Individual
DR. GEORGE DALE MULDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
802 N RIVERSIDE RD., STE G50, SAINT JOSEPH, MO 64507-2553
(816) 671-4888
(816) 671-4890
Mailing address
802 N. RIVERSIDE RD.,, STE. G50, SAINT JOSEPH, MO 64507-2553
(816) 671-4888
(816) 671-4890
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
R7297
MO
2086S0127X
Trauma Surgery Physician
R7297
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10001089301
COMMUNITY HEALTH PLAN
MO
05
—
100206190B
—
KS
05
—
201022217
—
MO
01
—
P00208226
RR MEDICARE
MO
Enumeration date
07/03/2006
Last updated
02/28/2011
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