MEDICARE: ERNEST N MISTR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	17303	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0101018666	OTHER	VA	MEDICAL LICENSE NUMBER
2	17303	OTHER	SC	MEDICAL LICENSE NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063484327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNEST N MISTR MD

Provider Business Mailing Address
First Line	:	317 WATERCREST DR
Second Line	:
City	:	INMAN
State	:	SC
Zip	:	29349-6940
Country	:	US
Telephone Number	:	864-592-9358
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 BOILING SPRINGS RD
Second Line	:	SUITE 1300
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-4201
Country	:	US
Telephone Number	:	864-560-6345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	09/16/2010

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Directions to “ ERNEST N MISTR MD” Practice Location

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