Provider Demographics
NPI:1487632519
Name:MULLINS, ROY C III (MD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:C
Last Name:MULLINS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CURTIS
Other - Middle Name:
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070
Mailing Address - Country:US
Mailing Address - Phone:405-292-5500
Mailing Address - Fax:405-292-5500
Practice Address - Street 1:901 N. PORTER
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071
Practice Address - Country:US
Practice Address - Phone:405-292-5500
Practice Address - Fax:405-292-5500
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26074207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1283814-04Medicaid
TX816801Medicare ID - Type UnspecifiedMEDICAR