Provider Demographics
NPI:1053735035
Name:DR B KRIS MULLINS MD PLLC
Entity type:Organization
Organization Name:DR B KRIS MULLINS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:B
Authorized Official - Middle Name:KRIS
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-306-3876
Mailing Address - Street 1:DEPT 96-0485
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0485
Mailing Address - Country:US
Mailing Address - Phone:405-306-3876
Mailing Address - Fax:405-843-5865
Practice Address - Street 1:1211 N SHARTEL AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2400
Practice Address - Country:US
Practice Address - Phone:405-604-6700
Practice Address - Fax:405-843-5865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19064207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK19054OtherLICENSE