Provider Demographics
NPI:1811972490
Name:ATHERTON, MICHAEL RP (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RP
Last Name:ATHERTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:ATHERTON, M.D.,PC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:38 RANCHO VERDE
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-7953
Mailing Address - Country:US
Mailing Address - Phone:505-286-1625
Mailing Address - Fax:425-740-9959
Practice Address - Street 1:38 RANCHO VERDE
Practice Address - Street 2:
Practice Address - City:TIJERAS
Practice Address - State:NM
Practice Address - Zip Code:87059-7953
Practice Address - Country:US
Practice Address - Phone:505-286-1625
Practice Address - Fax:425-740-9959
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17847207L00000X
NM2003-0123207L00000X
FLME 74597207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ784-0001OtherBC/BS
MD271791000Medicaid
MD271791000Medicaid
MD858MK402Medicare ID - Type Unspecified