Provider Demographics
NPI:1871597518
Name:MULLINS, JR, JAMES ERIC (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ERIC
Last Name:MULLINS, JR
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 1:2400 N ORANGE BLOSSOM TRL STE 300
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-2308
Mailing Address - Country:US
Mailing Address - Phone:407-846-7200
Mailing Address - Fax:407-846-3989
Practice Address - Street 1:2400 N ORANGE BLOSSOM TRL STE 300
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-2308
Practice Address - Country:US
Practice Address - Phone:407-846-7200
Practice Address - Fax:407-846-3989
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJM068606207V00000X
FLME144040207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4223111Medicaid
MI160050107OtherMEDICARE RAILROAD