Provider Demographics
NPI:1568575314
Name:RUTLEDGE, MICHAEL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:RUTLEDGE
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 1:4801 N BUTLER AVE
Mailing Address - Street 2:SUITE 13101
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6002
Mailing Address - Country:US
Mailing Address - Phone:505-564-8300
Mailing Address - Fax:505-564-8303
Practice Address - Street 1:4801 N BUTLER AVE
Practice Address - Street 2:SUITE 13101
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6002
Practice Address - Country:US
Practice Address - Phone:505-564-8300
Practice Address - Fax:505-564-8303
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM95-338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA101007Medicare PIN