Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | OP00002336 | WA |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | OP00002336 | WA |
NPI | 1942491196 |
---|---|
Provider Name | Dr. Brian James Mitchell |
First Address | Puyallup, WA 98371-0231 |
Second Address | Puyallup, WA 98374-1145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 16/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2006500 | (05) | WA |