Healthcare Provider Details

I. General information

NPI: 1407895691
Provider Name (Legal Business Name): ROBERT L MITCHELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6245 SHERIDAN DR SUITE 212
WILLIAMSVILLE NY
14221-4834
US

IV. Provider business mailing address

5250 VIRGINIA WAY SUITE 250
BRENTWOOD TN
37027
US

V. Phone/Fax

Practice location:
  • Phone: 716-204-4500
  • Fax: 716-204-4501
Mailing address:
  • Phone: 615-690-1941
  • Fax: 615-690-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number18648
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: