Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | J9214 | TX |
NPI | 1760605539 |
---|---|
Provider Name | Alfred Tennyson Mitchell |
First Address | Nassau Bay, TX 77058 |
Second Address | Houston, TX 77058-3631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 01/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H12915 | (02) | TX |