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NPI Code Detail

MEDICARE: HENRY HUSON MIDDLETON III MD

MEDICARE: HENRY HUSON MIDDLETON III MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QG0300XGeriatric Medicine (Family Medicine) Physician78-226NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063419547
Entity Type Code : Individual
Provider Name (Legal Business Name) : HENRY HUSON MIDDLETON III MD
Provider Business Mailing Address
First Line : 1524 EUBANK BLVD NE
Second Line : STE 6
City : ALBUQUERQUE
State : NM
Zip : 87112-4160
Country : US
Telephone Number : 760-449-4351
Fax Number : 866-530-1835
Provider Business Practice Location Address
First Line : 8208 LOUISIANA BLVD NE
Second Line : STE C
City : ALBUQUERQUE
State : NM
Zip : 87113-1757
Country : US
Telephone Number : 505-858-1222
Fax Number : 505-858-1224
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2005
Last Update Date : 08/21/2019

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