Provider Demographics
NPI:1871863829
Name:CHILDRESS, MICHAEL RAYMOND (PA)
Entity Type:Individual
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First Name:MICHAEL
Middle Name:RAYMOND
Last Name:CHILDRESS
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Gender:M
Credentials:PA
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Mailing Address - Street 1:5005 N PIEDRAS ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-742-6386
Mailing Address - Fax:915-569-4890
Practice Address - Street 1:5005 N PIEDRAS ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-742-6386
Practice Address - Fax:915-569-4890
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant