Healthcare Provider Details

I. General information

NPI: 1306872270
Provider Name (Legal Business Name): RON BENSON MITCHELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR SUITE 4740
DALLAS TX
75235-7701
US

IV. Provider business mailing address

5323 HARRY HINES BLVD
DALLAS TX
75390-7201
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-6713
  • Fax: 214-456-7644
Mailing address:
  • Phone: 214-456-6713
  • Fax: 214-456-7644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number44274
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: