Provider Demographics
NPI:1053412692
Name:MULLER, VINCENT (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:MULLER
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NEEL AVE
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-4649
Mailing Address - Country:US
Mailing Address - Phone:575-835-2940
Mailing Address - Fax:575-835-2216
Practice Address - Street 1:200 NEEL AVE
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-4649
Practice Address - Country:US
Practice Address - Phone:575-835-2940
Practice Address - Fax:575-835-2216
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM75000351Medicaid
NM75000351Medicaid
NMP01183310Medicare PIN