=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033201629
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL E MITCHELL M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2006
-----------------------------------------------------
Last Update Date | 06/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31860 US HIGHWAY 19 N
-----------------------------------------------------
City | PALM HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34684-3713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-787-6335
-----------------------------------------------------
Fax | 727-772-2160
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10537 STATE ROAD 54
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34655-1105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-376-8404
-----------------------------------------------------
Fax | 727-376-8552
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME76043
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------