Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 1113 | NV |
NPI | 1285633347 |
---|---|
Provider Name | Ryan Eric Mitchell |
First Address | Henderson, NV 89074-7329 |
Second Address | Henderson, NV 89074-7329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 10/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100500680 | (05) | NV |
H89974 | (02) |