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General NPI Number Information
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NPI Number | 1346297769
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Entity Type | Individual
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Provider Name | PAUL A MIKKELSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 801 W MAPLE ST
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City | FARMINGTON
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State | NM
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Zip | 87401-5630
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Country | US
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Telephone | 505-325-5011
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Fax | 505-324-2258
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Provider Business Mailing Address
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Address Line | PO BOX 844088
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City | DALLAS
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State | TX
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Zip | 75284-4088
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Country | US
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Telephone | 505-609-2000
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Fax | 505-609-2259
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD2005-0318
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License Number State | NM
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