Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 03787 | AL |
N | 204E00000X | Oral & Maxillofacial Surgeon | 17041 | AL |
NPI | 1053325167 |
---|---|
Provider Name | Dr. Phillip Anthony Mitchell |
First Address | Birmingham, AL 35242-6585 |
Second Address | Birmingham, AL 35242-6585 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06576 | BCBS # OF AL (01) | AL |
T93636 | (02) | AL |