Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 0101232430 | VA |
NPI | 1053354118 |
---|---|
Provider Name | Mr. Paul B Mitchell JR. |
First Address | Norfolk, VA 23510-1065 |
Second Address | Norfolk, VA 23510-1065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 26/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006101593 | (05) | VA |
H52188 | (02) |