Provider Demographics
NPI:1912316241
Name:MARK LULEY DO
Entity type:Organization
Organization Name:MARK LULEY DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LULEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:505-803-1748
Mailing Address - Street 1:4400 N BIG SPRING ST STE A9
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-4600
Mailing Address - Country:US
Mailing Address - Phone:505-803-1748
Mailing Address - Fax:
Practice Address - Street 1:4400 N BIG SPRING ST STE A9
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-4600
Practice Address - Country:US
Practice Address - Phone:505-803-1748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP14722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty