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NPI Code Detail

MEDICARE: GARY MITCHELL MD

MEDICARE: GARY MITCHELL 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
1207PE0004XEmergency Medical Services (Emergency Medicine) PhysicianD9574TX
2207P00000XEmergency Medicine PhysicianD9574TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750339602
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY MITCHELL MD
Provider Business Mailing Address
First Line : 13310 RANCH ROAD 12
Second Line :
City : WIMBERLEY
State : TX
Zip : 78676-5304
Country : US
Telephone Number : 512-842-1190
Fax Number :
Provider Business Practice Location Address
First Line : 901 W BEN WHITE BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78704-6903
Country : US
Telephone Number : 512-447-2211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 05/14/2010

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