Healthcare Provider Details

I. General information

NPI: 1750888285
Provider Name (Legal Business Name): MITCHELL WEST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 07/28/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 N PORTLAND AVE
OKLAHOMA CITY OK
73120-5045
US

IV. Provider business mailing address

11101 HEFNER POINTE DR STE 204
OKLAHOMA CITY OK
73120-5054
US

V. Phone/Fax

Practice location:
  • Phone: 405-936-1500
  • Fax:
Mailing address:
  • Phone: 405-936-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number39663
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: