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General NPI Number Information
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NPI Number | 1396913729
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Entity Type | Individual
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Provider Name | PATRICK DALE MULKEY MD
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Gender | Male
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 2100 LOUISIANA BLVD NE STE 410
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-5412
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Country | US
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Telephone | 505-724-4300
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Fax | 505-338-0034
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Provider Business Mailing Address
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Address Line | PO BOX 26666 PHS PROVIDER ENROLLMENT
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6666
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Country | US
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Telephone | 505-923-6770
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Fax | 505-923-5354
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 81993
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD2013-0461
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License Number State | NM
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