Provider Demographics
NPI:1720571185
Name:OFFUTT, MICHAEL EDMUND (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDMUND
Last Name:OFFUTT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5430 FREDERICKSBURG RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3539
Mailing Address - Country:US
Mailing Address - Phone:210-340-1212
Mailing Address - Fax:210-525-9617
Practice Address - Street 1:5430 FREDERICKSBURG RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3539
Practice Address - Country:US
Practice Address - Phone:210-340-1212
Practice Address - Fax:210-525-9617
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCLL52607207R00000X
IL036.159790207W00000X
TXBP10067768207W00000X
TXV0492207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine