Basic Information
Provider Information
NPI: 1154528370
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MULKEY
FirstName: ZACHARY
MiddleName: PAUL
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5865
Address2:  
City: LUBBOCK
State: TX
PostalCode: 794085865
CountryCode: US
TelephoneNumber: 8067433150
FaxNumber: 8067433168
Practice Location
Address1: 3601 4TH ST
Address2:  
City: LUBBOCK
State: TX
PostalCode: 794309410
CountryCode: US
TelephoneNumber: 8067433150
FaxNumber: 8067433168
Other Information
ProviderEnumerationDate: 06/29/2007
LastUpdateDate: 06/03/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/03/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XM7455TXY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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