Healthcare Provider Details

I. General information

NPI: 1124069471
Provider Name (Legal Business Name): MICHAEL SCOTT SELIGSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 PAN AMERICAN FWY NE STE. 224
ALBUQUERQUE NM
87107
US

IV. Provider business mailing address

4343 PAN AMERICAN FWY NE. STE. 224
ALBUQUERQUE NM
87107
US

V. Phone/Fax

Practice location:
  • Phone: 505-344-5400
  • Fax: 505-344-5404
Mailing address:
  • Phone: 505-344-5400
  • Fax: 505-344-5404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD2004-0206
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: