Healthcare Provider Details

I. General information

NPI: 1629069885
Provider Name (Legal Business Name): PATRICK JAMES MULLEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 W IRONWOOD CENTER DR
COEUR D ALENE ID
83814-2639
US

IV. Provider business mailing address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-4680
  • Fax: 208-625-4681
Mailing address:
  • Phone: 208-625-5085
  • Fax: 208-625-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberM8506
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberM-8506
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: