Individual
MARK MCMULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6201 N SUNCOAST BLVD, CRYSTAL RIVER, FL 34428-6712
(352) 621-3100
(352) 621-3121
Mailing address
PO BOX 2030, HOMOSASSA SPRINGS, FL 34447-2030
(352) 621-3100
(352) 621-3121
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME49726
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27507
BLUE CROSS BLUE SHIELD
FL
05
—
378304900
—
FL
Enumeration date
07/25/2006
Last updated
03/20/2019
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