Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 024342 | LA |
N | 207P00000X | Emergency Physician | 057221 | GA |
Y | 207P00000X | Emergency Physician | D69403 | MD |
N | 207RC0200X | Critical Care Medicine | 024342 | LA |
N | 207RC0200X | Critical Care Medicine | 057221 | GA |
N | 207RC0200X | Critical Care Medicine | D69403 | MD |
NPI | 1013968080 |
---|---|
Provider Name | Dr. Anthony L Mitchell |
First Address | Jacksonville, FL 32256-0566 |
Second Address | Baltimore, MD 21201-1544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 29/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0137 | BLUE CROSS (01) | GA |
0137 | BLUE CROSS (01) | MD |
342360871A | (05) | GA |
342360871B | (05) | GA |
361896 | WELLCARE (01) | GA |
419682100 | (05) | MD |
52173131 | BCBS (01) | GA |
H34953 | (02) | GA |
P00334342 | RAILRAOD MEDICARE (01) | GA |