MEDICARE: DR. RODGER MITCHELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	J4359	TX
2	207Q00000X	Family Medicine Physician	22412	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	82G884	OTHER	TX	BCBS
3	80849Z	OTHER	TX	HMO BLUE
4	A110	OTHER	NM	TRIWEST

General Provider Information

NPI Number	:	1750373700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODGER MITCHELL M.D.

Provider Business Mailing Address
First Line	:	605 S WEST ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010
Country	:	US
Telephone Number	:	817-272-2773
Fax Number	:	817-272-2744

Provider Business Practice Location Address
First Line	:	605 S WEST ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010
Country	:	US
Telephone Number	:	817-272-2773
Fax Number	:	817-272-2744

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	10/25/2007

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