Provider Demographics
NPI:1285958017
Name:MCFADDEN, MICHAEL WAYNE (IDMT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:MCFADDEN
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 SAGUARO LOOP
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-7775
Mailing Address - Country:US
Mailing Address - Phone:402-415-5043
Mailing Address - Fax:
Practice Address - Street 1:2309 SAGUARO LOOP
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-7775
Practice Address - Country:US
Practice Address - Phone:402-415-5043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians