Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 20A5684 | CA |
NPI | 1003925926 |
---|---|
Provider Name | Albert M Mitchell |
First Address | Fairfield, CA 94533-4897 |
Second Address | Fairfield, CA 94533-4897 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 21/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F15275 | (02) |