Healthcare Provider Details

I. General information

NPI: 1114323763
Provider Name (Legal Business Name): RYAN E. MITCHELL DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 N PECOS RD SUITE C
HENDERSON NV
89074-7329
US

IV. Provider business mailing address

54 N PECOS RD SUITE C
HENDERSON NV
89074-7329
US

V. Phone/Fax

Practice location:
  • Phone: 702-376-3095
  • Fax: 702-946-1687
Mailing address:
  • Phone: 702-376-3095
  • Fax: 702-946-1687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number1113
License Number StateNV

VIII. Authorized Official

Name: DR. RYAN E MITCHELL
Title or Position: OWNER
Credential: D.O.
Phone: 702-376-3095