Healthcare Provider Details

I. General information

NPI: 1750339651
Provider Name (Legal Business Name): JERRY MITCHELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 WILDCAT RUN CT
POWELL OH
43065-5112
US

IV. Provider business mailing address

2315 WILDCAT RUN CT
POWELL OH
43065-5112
US

V. Phone/Fax

Practice location:
  • Phone: 614-406-1926
  • Fax:
Mailing address:
  • Phone: 614-406-1926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number35082344
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number35082344
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: