Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | P3391 | TX |
N | 208600000X | Surgeon | P3391 | TX |
Y | 2086S0120X | Pediatric Surgery | P3391 | TX |
NPI | 1538336367 |
---|---|
Provider Name | Dr. Ian Crichton Slight Mitchell |
First Address | San Antonio, TX 78229-3853 |
Second Address | San Antonio, TX 78229-3853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2008 |
Last Update Date | 29/08/2012 |