Provider Demographics
NPI:1265496012
Name:MITCHELL, BRIAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:C
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NW 13TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2350
Mailing Address - Country:US
Mailing Address - Phone:561-391-3333
Mailing Address - Fax:561-391-4420
Practice Address - Street 1:900 NW 13TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2350
Practice Address - Country:US
Practice Address - Phone:561-391-3333
Practice Address - Fax:561-391-4420
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD64638Medicare UPIN
FL93889YMedicare ID - Type Unspecified