Provider Demographics
NPI:1275678492
Name:FOOTE, MICHAEL WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:FOOTE
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 1:5920 CROMO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5526
Mailing Address - Country:US
Mailing Address - Phone:915-532-3697
Mailing Address - Fax:915-532-3506
Practice Address - Street 1:5920 CROMO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5526
Practice Address - Country:US
Practice Address - Phone:915-532-3697
Practice Address - Fax:915-532-3506
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8901207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151115602Medicaid
TXH59046Medicare UPIN
TX5600810001Medicare NSC
TX8F1770Medicare PIN