Healthcare Provider Details

I. General information

NPI: 1851404230
Provider Name (Legal Business Name): DAVID BRUCE MITCHELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13636 SE TARALON DR
CLACKAMAS OR
97015
US

IV. Provider business mailing address

13636 SE TARALON DR
CLACKAMAS OR
97015
US

V. Phone/Fax

Practice location:
  • Phone: 503-266-5500
  • Fax:
Mailing address:
  • Phone: 503-266-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD15466
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD15466
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: