Provider Demographics
NPI:1487614616
Name:MCMULLEN, CRAIG (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:MCMULLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 N PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:TX
Mailing Address - Zip Code:75773-1054
Mailing Address - Country:US
Mailing Address - Phone:903-569-6124
Mailing Address - Fax:903-567-2467
Practice Address - Street 1:1220 N PACIFIC ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-1054
Practice Address - Country:US
Practice Address - Phone:903-569-6124
Practice Address - Fax:903-567-2467
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6742207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163696101Medicaid
TX163696102Medicaid
TX0063KHOtherBLUE CROSS PROVIDER #
TX163696101Medicaid
TXH92335Medicare UPIN
TX200081642OtherEIN