Healthcare Provider Details

I. General information

NPI: 1861650475
Provider Name (Legal Business Name): ARTUR GERARD MIXA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 MEMORIAL DR
PINEHURST NC
28374-8710
US

IV. Provider business mailing address

PO BOX 3000
PINEHURST NC
28374-3000
US

V. Phone/Fax

Practice location:
  • Phone: 910-715-2164
  • Fax: 910-715-4493
Mailing address:
  • Phone: 910-715-2164
  • Fax: 910-715-4493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberPENDING
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: