Provider Demographics
NPI:1073669453
Name:AMSDEN, MICHAEL NANCY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:NANCY
Last Name:AMSDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 DELAWARE ST
Mailing Address - Street 2:SUITE 601-A
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3067
Mailing Address - Country:US
Mailing Address - Phone:800-258-2016
Mailing Address - Fax:409-924-9696
Practice Address - Street 1:3560 DELAWARE ST
Practice Address - Street 2:SUITE 601-A
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3067
Practice Address - Country:US
Practice Address - Phone:800-258-2016
Practice Address - Fax:409-924-9696
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4791207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4625783OtherAETNA
TX8R0107OtherBLUE CROSS BLUE SHIELD
TX8C2244Medicare ID - Type Unspecified
TX8R0107OtherBLUE CROSS BLUE SHIELD