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General NPI Number Information
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NPI Number | 1083694061
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Entity Type | Individual
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Provider Name | MARK JOSEPH MITCHELL PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 11/05/2017
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Provider Practice Location Address
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Address Line | 5750 W THUNDERBIRD RD SUITE B200
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City | GLENDALE
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State | AZ
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Zip | 85306-4660
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Country | US
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Telephone | 602-375-1700
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Fax | 602-987-1228
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Provider Business Mailing Address
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Address Line | 1776 N SCOTTSDALE RD UNIT 368
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City | SCOTTSDALE
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State | AZ
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Zip | 85252-3616
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Country | US
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Telephone | 480-201-5264
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Fax | 480-393-1970
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3088
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License Number State | AZ
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