Healthcare Provider Details

I. General information

NPI: 1265603351
Provider Name (Legal Business Name): MITCHELL C. SHIRAH M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59664 HIGHWAY 22
ROANOKE AL
36274-4438
US

IV. Provider business mailing address

59664 HIGHWAY 22
ROANOKE AL
36274-4438
US

V. Phone/Fax

Practice location:
  • Phone: 334-863-8951
  • Fax: 334-863-2361
Mailing address:
  • Phone: 334-863-8951
  • Fax: 334-863-2361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9705
License Number StateAL

VIII. Authorized Official

Name: MRS. STEPHANIE LYNN ESTES
Title or Position: OFFICE MANAGER
Credential: RN, BSN
Phone: 334-863-8951