Provider Demographics
NPI:1043287147
Name:MULKEY, LOUIS EDGAR (DO)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:EDGAR
Last Name:MULKEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1334 N LANSING AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-5907
Mailing Address - Country:US
Mailing Address - Phone:918-587-2171
Mailing Address - Fax:918-295-6106
Practice Address - Street 1:1111 S ST LOUIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120
Practice Address - Country:US
Practice Address - Phone:918-619-4600
Practice Address - Fax:918-619-4601
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2018-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK3479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100071920DMedicaid