Healthcare Provider Details

I. General information

NPI: 1104908797
Provider Name (Legal Business Name): MITCHELL J FLAXMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 S OLD DIXIE HWY SUITE 201
JUPITER FL
33458-7202
US

IV. Provider business mailing address

5431 N UNIVERSITY DR
CORAL SPRINGS FL
33067-4639
US

V. Phone/Fax

Practice location:
  • Phone: 561-744-2200
  • Fax: 561-744-3083
Mailing address:
  • Phone: 954-344-2522
  • Fax: 954-344-9189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME0046424
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: