Healthcare Provider Details

I. General information

NPI: 1770567315
Provider Name (Legal Business Name): PAUL A MITCHELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 N CIRCLE DR
COLORADO SPRINGS CO
80909-1179
US

IV. Provider business mailing address

7951 E MAPLEWOOD AVE
GREENWOOD VILLAGE CO
80111-4723
US

V. Phone/Fax

Practice location:
  • Phone: 719-577-2555
  • Fax: 719-667-6998
Mailing address:
  • Phone: 303-930-7800
  • Fax: 303-930-7860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number37731
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: