Provider Demographics
NPI:1700955192
Name:STATTON, MICHAEL JOE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOE
Last Name:STATTON
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 1:7330 SAN PEDRO AVE STE 540
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6250
Mailing Address - Country:US
Mailing Address - Phone:210-344-7287
Mailing Address - Fax:210-344-2649
Practice Address - Street 1:7330 SAN PEDRO AVE STE 540
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6250
Practice Address - Country:US
Practice Address - Phone:210-344-7287
Practice Address - Fax:210-344-2649
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ76967390200000X
AZ42441207R00000X
TXQ1510207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341316301Medicaid
AZBC7786140-S28OtherDEA NUMBER IN RESIDENCY
TXFS4297063OtherDEA