Provider Demographics
NPI:1104893536
Name:MIDDLEBROOK, MICHAEL R (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:MIDDLEBROOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8401 DATAPOINT DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5900
Mailing Address - Country:US
Mailing Address - Phone:210-616-7700
Mailing Address - Fax:210-616-7709
Practice Address - Street 1:8401 DATAPOINT DR
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5900
Practice Address - Country:US
Practice Address - Phone:210-616-7700
Practice Address - Fax:210-616-7709
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH64372085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH6437OtherTEXAS MEDICAL LICENSE
TX128928207Medicaid
TX1289282-08Medicaid
TX128928206Medicaid
TXH6437OtherTEXAS MEDICAL LICENSE
TX128928206Medicaid
TX1289282-08Medicaid
TX300125889Medicare PIN
TX300125889Medicare PIN