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General NPI Number Information
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NPI Number | 1104908797
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Entity Type | Individual
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Provider Name | MITCHELL J FLAXMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 1002 S OLD DIXIE HWY SUITE 201
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City | JUPITER
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State | FL
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Zip | 33458-7202
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Country | US
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Telephone | 561-744-2200
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Fax | 561-744-3083
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Provider Business Mailing Address
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Address Line | 5431 N UNIVERSITY DR
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-4639
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Country | US
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Telephone | 954-344-2522
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Fax | 954-344-9189
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME0046424
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License Number State | FL
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