Healthcare Provider Details

I. General information

NPI: 1285633347
Provider Name (Legal Business Name): RYAN ERIC MITCHELL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
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 Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number1113
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: