Provider Demographics
NPI:1992817993
Name:MUFFOLETTO, ANTHONY JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:MUFFOLETTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 590647
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77259-0647
Mailing Address - Country:US
Mailing Address - Phone:832-864-3407
Mailing Address - Fax:281-335-5520
Practice Address - Street 1:1110 NASA PKWY STE 307
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3345
Practice Address - Country:US
Practice Address - Phone:832-864-3047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9854207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01070710OtherRR MEDICARE
TX040029305Medicaid
TX040029307Medicaid
TX5521704OtherAETNA
TX8BP175OtherBLUE CROSS BLUE SHIELD
TX610119705OtherUS DEPT OF LABOR
TX040029303Medicaid
TX040029304Medicaid
TX040029306Medicaid
TXP00732782OtherRAILROAD MEDICARE
TX5521704OtherAETNA
TX8BP175OtherBLUE CROSS BLUE SHIELD
TX8A8542Medicare PIN
TX8F9761Medicare PIN
TX040029306Medicaid
TX040029307Medicaid