Provider Demographics
NPI:1063419547
Name:MIDDLETON, HENRY HUSON III (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:HUSON
Last Name:MIDDLETON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1524 EUBANK BLVD NE
Mailing Address - Street 2:STE 6
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-4160
Mailing Address - Country:US
Mailing Address - Phone:760-449-4351
Mailing Address - Fax:866-530-1835
Practice Address - Street 1:8208 LOUISIANA BLVD NE
Practice Address - Street 2:STE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1757
Practice Address - Country:US
Practice Address - Phone:505-858-1222
Practice Address - Fax:505-858-1224
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM78-226207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM06064Medicaid
NM06064Medicaid
NM444414YNMTMedicare PIN
NME09296Medicare UPIN
NM6064Medicaid