Provider Demographics
NPI:1063875490
Name:MULLOY, EVAN ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:ANTHONY
Last Name:MULLOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:13009 S PARKER RD UNIT 393
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3449
Mailing Address - Country:US
Mailing Address - Phone:720-666-4739
Mailing Address - Fax:833-449-4351
Practice Address - Street 1:1400 N COIT RD STE 302
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-6656
Practice Address - Country:US
Practice Address - Phone:469-722-5700
Practice Address - Fax:833-449-4351
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-02
Last Update Date:2024-04-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA92615208800000X
CODR.0072249208800000X
TXU8100208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology