Provider Demographics
NPI:1245229665
Name:PRICE, MICHAEL DEWAYNE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DEWAYNE
Last Name:PRICE
Suffix:
Gender:M
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:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-1198
Mailing Address - Country:US
Mailing Address - Phone:325-670-4220
Mailing Address - Fax:325-670-4040
Practice Address - Street 1:1900 PINE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2432
Practice Address - Country:US
Practice Address - Phone:325-670-4220
Practice Address - Fax:325-670-4040
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3688207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8X2410OtherBCBS IND # PAIN
TX166752901Medicaid
TX166752903Medicaid
TX8V0632OtherBCBSTX
TX166752904Medicaid
TX8F3179Medicare UPIN
TX8G8608Medicare PIN
TX8C1367Medicare PIN
TX166752901Medicaid