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General NPI Number Information
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NPI Number | 1770427171
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Entity Type | Organization
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Legal Business Name | SAINT JOHNS PLASTIC SURGERY PLLC
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Dates
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Enumeration Date | 04/16/2026
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Last Update Date | 04/24/2026
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Provider Practice Location Address
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Address Line | 304 ASHOURIAN AVE STE 107
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092-5110
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Country | US
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Telephone | 281-630-1127
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Fax |
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Provider Business Mailing Address
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Address Line | 512 COURTNEY OAKS DR
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092-1999
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Country | US
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Telephone | 281-630-1127
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Fax |
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Authorized Official
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Title or Position | MEMBER/PLASTIC SURGEON
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Name | MATTHEW BRETT MITCHELL
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Credential | MD
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Telephone | 904-657-4103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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