Healthcare Provider Details

I. General information

NPI: 1013990373
Provider Name (Legal Business Name): MICHAEL J HOUGHTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E PROSPECT RD
FORT COLLINS CO
80525-9718
US

IV. Provider business mailing address

2500 E PROSPECT RD
FORT COLLINS CO
80525-9718
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-0112
  • Fax:
Mailing address:
  • Phone: 970-493-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberDR.0036332
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: