Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | Q6450 | TX |
N | 2080P0204X | Pediatric Emergency Doctor | ME55957 | FL |
NPI | 1396768123 |
---|---|
Provider Name | Dr. James R Mitchell |
First Address | Panama City, FL 32405-4852 |
Second Address | Houston, TX 77030-2358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 24/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
059099100 | (05) | FL |
10626BC | (02) | FL |