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NPI Code Detail

MEDICARE: DR. ROBERT MIXSELL MD

MEDICARE: DR. ROBERT MIXSELL 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
1207Q00000XFamily Medicine Physician35712IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598717449
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT MIXSELL MD
Provider Business Mailing Address
First Line : 1345 W CENTRAL PARK AVE
Second Line :
City : DAVENPORT
State : IA
Zip : 52804-1844
Country : US
Telephone Number : 563-421-4400
Fax Number : 563-421-4449
Provider Business Practice Location Address
First Line : 1345 W CENTRAL PARK AVE
Second Line :
City : DAVENPORT
State : IA
Zip : 52804-1844
Country : US
Telephone Number : 563-421-4400
Fax Number : 563-421-4449
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 08/23/2021

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