=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548230139
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID RAY MITCHELL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2006
-----------------------------------------------------
Last Update Date | 02/22/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 2ND AVE SW
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74354-6830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-540-7434
-----------------------------------------------------
Fax | 918-540-7473
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5300 N INDEPENDENCE AVE 280
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73112-5556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-540-7434
-----------------------------------------------------
Fax | 918-540-7473
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 19340
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------