Provider Demographics
NPI:1730157173
Name:MUSSON, PAUL HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HENRY
Last Name:MUSSON
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:G3500 FLUSHING RD
Mailing Address - Street 2:#300
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504
Mailing Address - Country:US
Mailing Address - Phone:810-733-6980
Mailing Address - Fax:810-230-9250
Practice Address - Street 1:G3500 FLUSHING RD
Practice Address - Street 2:#300
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504
Practice Address - Country:US
Practice Address - Phone:810-733-6980
Practice Address - Fax:810-230-9250
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045140207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0229111OtherHT
1102535022OtherBCBS
MI1555243Medicaid
1102535022OtherBCBS
02535029112Medicare ID - Type Unspecified