Basic Information
| Provider Information | |||||||||
| NPI: | 1861409542 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULKEY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4230 BURNHAM AVENUE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891195408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027337866 | ||||||||
| FaxNumber: | 7027921319 | ||||||||
| Practice Location | |||||||||
| Address1: | 4230 BURNHAM AVE. | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891195408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027337866 | ||||||||
| FaxNumber: | 7027921319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZC0500X | 2880 | NV | N | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZH0000X | 2880 | NV | N | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207ZP0102X | 2880 | NV | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 200290404 | 05 | NV | MEDICAID |