Healthcare Provider Details

I. General information

NPI: 1164422127
Provider Name (Legal Business Name): EDMUND M MITCHELL I MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 04/23/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E MAIN ST BLDG B
SOMERTON AZ
85350-7409
US

IV. Provider business mailing address

PO BOX 617
SOMERTON AZ
85350-0617
US

V. Phone/Fax

Practice location:
  • Phone: 928-236-8001
  • Fax: 928-627-1509
Mailing address:
  • Phone: 928-662-0406
  • Fax: 928-662-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number43534
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: