Healthcare Provider Details

I. General information

NPI: 1164563631
Provider Name (Legal Business Name): ROBERT E MITCHELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6802 S OLYMPIA AVE
TULSA OK
74132-1823
US

IV. Provider business mailing address

11911 S MEMORIAL DR
BIXBY OK
74008-2030
US

V. Phone/Fax

Practice location:
  • Phone: 918-504-0364
  • Fax:
Mailing address:
  • Phone: 918-943-3790
  • Fax: 918-943-3793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number22998
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22998
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: