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General NPI Number Information
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NPI Number | 1174836985
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Entity Type | Organization
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Legal Business Name | CHARLES D. MITCHELL MD PA
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Dates
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Enumeration Date | 07/21/2010
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Last Update Date | 07/21/2010
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Provider Practice Location Address
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Address Line | 3500 I-30 STE C101
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City | MESQUITE
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State | TX
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Zip | 75150-2676
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Country | US
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Telephone | 972-682-1307
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Fax | 972-686-2546
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Provider Business Mailing Address
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Address Line | 3500 I-30 STE C101
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City | MESQUITE
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State | TX
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Zip | 75150-2676
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Country | US
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Telephone | 972-682-1307
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Fax | 972-686-2546
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES D MITCHELL
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Credential | MD
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Telephone | 972-682-1307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | E1680
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License Number State | TX
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