Individual
DR. JOHN LAIRD MCMULLEN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 E DIXIE AVE, SUITE 104, LEESBURG, FL 34748-7699
(352) 365-2583
(352) 728-6749
Mailing address
734 N 3RD ST, SUITE 115, LEESBURG, FL 34748-5285
(352) 365-2583
(352) 728-6749
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
ME93848
FL
207RM1200X
Magnetic Resonance Imaging (MRI) Internal Medicine Physician
93848
FL
2085R0202X
Diagnostic Radiology Physician
93849
FL
2085R0204X
Vascular & Interventional Radiology Physician
Primary
93848
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000070900
—
FL
01
—
P00656356
RR MEDICARE LMIV
FL
01
—
P00656364
RR MEDICARE RACF
FL
Enumeration date
06/09/2007
Last updated
02/24/2016
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