Individual
DR. SHANE R MULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3209 COLONIAL DR, USC- FAMILY & PREVENTIVE MEDICINE, COLUMBIA, SC 29203-6930
(803) 434-6113
(803) 434-7231
Mailing address
234 WESTLAKE FARMS DR, BLYTHEWOOD, SC 29016-8325
(803) 917-9333
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
23962
SC
207Q00000X
Family Medicine Physician
2009-01329
NC
207Q00000X
Family Medicine Physician
Primary
23962
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LL4378
—
SC
Enumeration date
08/10/2006
Last updated
03/26/2015
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