MEDICARE: ELIZABETH L. MITCHELL MD PA

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	2084P0804X	Child & Adolescent Psychiatry Physician

General Provider Information

NPI Number	:	1811139058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH L. MITCHELL MD PA

Provider Business Mailing Address
First Line	:	11124 WURZBACH RD STE 300
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-2445
Country	:	US
Telephone Number	:	210-694-2438
Fax Number	:	210-694-2439

Provider Business Practice Location Address
First Line	:	11124 WURZBACH RD STE 300
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-2445
Country	:	US
Telephone Number	:	210-694-2438
Fax Number	:	210-694-2439

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ELIZABETH L. MITCHELL
Credential	:	M.D.
Telephone Number	:	210-694-2438

Provider Enumeration Date	:	04/02/2009
Last Update Date	:	04/02/2009

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