Provider Demographics
NPI:1174836985
Name:CHARLES D. MITCHELL MD PA
Entity Type:Organization
Organization Name:CHARLES D. MITCHELL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-682-1307
Mailing Address - Street 1:3500 I-30 STE C101
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2676
Mailing Address - Country:US
Mailing Address - Phone:972-682-1307
Mailing Address - Fax:972-686-2546
Practice Address - Street 1:3500 I-30 STE C101
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2676
Practice Address - Country:US
Practice Address - Phone:972-682-1307
Practice Address - Fax:972-686-2546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1680207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty