Provider Demographics
NPI:1083007090
Name:BORTON, MICHAEL THOMAS (AA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THOMAS
Last Name:BORTON
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:400 CONCORD PLAZA DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6905
Mailing Address - Country:US
Mailing Address - Phone:210-804-5400
Mailing Address - Fax:210-678-4142
Practice Address - Street 1:400 CONCORD PLAZA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6905
Practice Address - Country:US
Practice Address - Phone:210-253-2660
Practice Address - Fax:210-253-2675
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2017-04-06
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX539469YLLUMedicare PIN