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NPI Code Detail

MEDICARE: MR. BRIAN CARLTON MITCHELL PTA

MEDICARE: MR. BRIAN CARLTON MITCHELL PTA
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
1171W00000XContractor1402OK

General Provider Information

NPI Number : 1689892663
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRIAN CARLTON MITCHELL PTA
Provider Business Mailing Address
First Line : 1823 S LINDSAY AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73129-4431
Country : US
Telephone Number : 405-640-7253
Fax Number : 405-721-2025
Provider Business Practice Location Address
First Line : 6525 N MERIDIAN AVE
Second Line : SUITE 311
City : OKLAHOMA CITY
State : OK
Zip : 73116-1420
Country : US
Telephone Number : 405-721-1115
Fax Number : 866-721-2025
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2007
Last Update Date : 07/08/2007

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