Individual
MR. MILTON ALLEN MATTESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
465 SAINT MICHAELS DR, SUITE 110, SANTA FE, NM 87505-7670
(505) 982-3534
Mailing address
465 SAINT MICHAELS DR, SUITE 110, SANTA FE, NM 87505-7670
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2003-0039
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34172866
—
NM
Enumeration date
08/31/2005
Last updated
05/25/2016
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