Provider Demographics
NPI:1003391152
Name:ROODVOETS, MITCHELL (NMD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:ROODVOETS
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 E BASELINE RD STE E-121
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2689
Mailing Address - Country:US
Mailing Address - Phone:480-719-5119
Mailing Address - Fax:
Practice Address - Street 1:3651 E BASELINE RD STE E-121
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2689
Practice Address - Country:US
Practice Address - Phone:480-719-5119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18-1722175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath