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NPI Code Detail

MEDICARE: MARK C D MITCHELL MD

MEDICARE: MARK C D 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
1207P00000XEmergency Medicine Physician10409AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
251555549OTHERALBLUE CROSS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811937154
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK C D MITCHELL MD
Provider Business Mailing Address
First Line : PO BOX 863535
Second Line :
City : ORLANDO
State : FL
Zip : 32886-3535
Country : US
Telephone Number : 904-805-1300
Fax Number : 904-805-1302
Provider Business Practice Location Address
First Line : 401 MEDICAL PARK DR
Second Line :
City : ATMORE
State : AL
Zip : 36502-3006
Country : US
Telephone Number : 904-805-1300
Fax Number : 904-805-1302
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2006
Last Update Date : 04/10/2008

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