Healthcare Provider Details

I. General information

NPI: 1407937675
Provider Name (Legal Business Name): GORDON MURRAY MITTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 H ST
BAKERSFIELD CA
93301-2817
US

IV. Provider business mailing address

2300 PINE ST
BAKERSFIELD CA
93301-3431
US

V. Phone/Fax

Practice location:
  • Phone: 661-324-7208
  • Fax: 661-324-3403
Mailing address:
  • Phone: 661-631-2790
  • Fax: 661-631-2789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG357290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: