Healthcare Provider Details

I. General information

NPI: 1376246462
Provider Name (Legal Business Name): SCOTT MITCHELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S GREENFIELD RD STE 101
MESA AZ
85206-5505
US

IV. Provider business mailing address

7301 E 2ND ST STE 210
SCOTTSDALE AZ
85251-5620
US

V. Phone/Fax

Practice location:
  • Phone: 480-964-5800
  • Fax:
Mailing address:
  • Phone: 480-882-4890
  • Fax: 480-882-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number011457
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: