Provider Demographics
NPI:1881815462
Name:LULEY, MARK M (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:M
Last Name:LULEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 CAMINO CORTO NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-6154
Mailing Address - Country:US
Mailing Address - Phone:505-489-2238
Mailing Address - Fax:
Practice Address - Street 1:5901 CAMINO CORTO NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-6154
Practice Address - Country:US
Practice Address - Phone:505-489-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0000002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry