Healthcare Provider Details

I. General information

NPI: 1437126802
Provider Name (Legal Business Name): TIMOTHY A MITCHELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 WILLAMETTE ST STE 330
EUGENE OR
97401
US

IV. Provider business mailing address

859 WILLAMETTE ST STE 330
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-344-5363
  • Fax: 541-344-5369
Mailing address:
  • Phone: 541-344-5363
  • Fax: 541-344-5369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD24791
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: