Provider Demographics
NPI:1477059012
Name:ALBERTSON, MICHAEL ANTHONY (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:ALBERTSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:ALBERTSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:7725 N 43RD AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-5775
Mailing Address - Country:US
Mailing Address - Phone:623-931-9201
Mailing Address - Fax:623-931-2116
Practice Address - Street 1:7725 N 43RD AVE STE 111
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-5775
Practice Address - Country:US
Practice Address - Phone:623-931-9201
Practice Address - Fax:623-931-2116
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7037363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant