Active NPI
Daniel S Mullooly, LMT
- Contractor
- Portland, OR
National Provider Identifier
1285820902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 13294 LMT
- Practice address
- 4402 SE Flavel St
Portland, OR 97206-8428 - Phone
- (503) 781-4388
- NPI assigned
- Sep 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 13294 LMT | OR | Primary |
Addresses
Primary practice location
4402 SE Flavel St
Portland, OR 97206-8428
Mailing address
4402 SE Flavel St
Portland, OR 97206-8428
Phone (503) 781-4388
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13294 LMT | OR | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358208000000",
"number": "1285820902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4402 SE FLAVEL ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972068428",
"telephone_number": "503-781-4388"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4402 SE FLAVEL ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972068428",
"telephone_number": "503-781-4388"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLOOLY",
"first_name": "DANIEL",
"middle_name": "S",
"name_prefix": "Mr.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-16",
"last_updated": "2013-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "OR",
"license": "13294 LMT",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.