Healthcare Provider Details

I. General information

NPI: 1356341721
Provider Name (Legal Business Name): CHARLES HOWARD MITCHELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MELVILLE DR
PAULS VALLEY OK
73075-6600
US

IV. Provider business mailing address

200 MELVILLE DR
PAULS VALLEY OK
73075-6600
US

V. Phone/Fax

Practice location:
  • Phone: 405-238-5555
  • Fax: 405-238-6348
Mailing address:
  • Phone: 405-238-5555
  • Fax: 405-238-6348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2248
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: