Healthcare Provider Details

I. General information

NPI: 1255264560
Provider Name (Legal Business Name): JUSTIN ADRIAN MITCHELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 PRAIRIE PKWY STE 205
CEDAR FALLS IA
50613-8155
US

IV. Provider business mailing address

1112 BYRON AVE
WATERLOO IA
50702-3131
US

V. Phone/Fax

Practice location:
  • Phone: 319-222-2711
  • Fax:
Mailing address:
  • Phone: 309-453-2891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-13882
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: