Healthcare Provider Details

I. General information

NPI: 1336378231
Provider Name (Legal Business Name): G. M. MITTS, M. D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 H ST
BAKERSFIELD CA
93301-2817
US

IV. Provider business mailing address

2525 H ST
BAKERSFIELD CA
93301-2817
US

V. Phone/Fax

Practice location:
  • Phone: 661-324-7208
  • Fax: 661-324-3403
Mailing address:
  • Phone: 661-324-7208
  • Fax: 661-324-3403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG35729
License Number StateCA

VIII. Authorized Official

Name: DR. GORDON MURRAY MITTS
Title or Position: PRESIDENT
Credential: M. D.
Phone: 661-324-3403