MEDICARE: JAMES MICHAEL MULKEY DDS MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	HDL - 813	CO

General Provider Information

NPI Number	:	1942292982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES MICHAEL MULKEY DDS MS

Provider Business Mailing Address
First Line	:	375 E PARK AVE
Second Line	:	SUITE 301
City	:	DURANGO
State	:	CO
Zip	:	81301-5012
Country	:	US
Telephone Number	:	970-247-0240
Fax Number	:	970-259-9004

Provider Business Practice Location Address
First Line	:	375 E PARK AVE
Second Line	:	SUITE 301
City	:	DURANGO
State	:	CO
Zip	:	81301-5012
Country	:	US
Telephone Number	:	970-247-0240
Fax Number	:	970-259-9004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/08/2007

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