Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1379 | MA |
NPI | 1902951767 |
---|---|
Provider Name | Dr. John B Mitchell |
First Address | Clinton, MA 01510-2612 |
Second Address | Clinton, MA 01510-2612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T90163 | (02) | MA |