Healthcare Provider Details

I. General information

NPI: 1871177105
Provider Name (Legal Business Name): GABRIEL JAMES MITCHELL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 BERT KOUNS INDUSTRIAL LOOP STE 200
SHREVEPORT LA
71106-8158
US

IV. Provider business mailing address

592 UNADILLA ST
SHREVEPORT LA
71106-1240
US

V. Phone/Fax

Practice location:
  • Phone: 318-687-8447
  • Fax: 318-687-9950
Mailing address:
  • Phone: 318-519-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number340437
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: