MEDICARE: SAINT JOHNS PLASTIC SURGERY PLLC

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	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1770427171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT JOHNS PLASTIC SURGERY PLLC

Provider Business Mailing Address
First Line	:	512 COURTNEY OAKS DR
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-1999
Country	:	US
Telephone Number	:	281-630-1127
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 ASHOURIAN AVE STE 107
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-5110
Country	:	US
Telephone Number	:	281-630-1127
Fax Number	:

Authorized Official
Title or Position	:	MEMBER/PLASTIC SURGEON
Name	:	MATTHEW BRETT MITCHELL
Credential	:	MD
Telephone Number	:	904-657-4103

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/24/2026

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