Provider Demographics
NPI:1346295060
Name:MITCHELL, SAMUEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:J
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 173260
Mailing Address - Street 2:MONTANA STATE UNIVERSITY STUDENT HEALTH SERVICE
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59717-3260
Mailing Address - Country:US
Mailing Address - Phone:406-994-2311
Mailing Address - Fax:406-994-2504
Practice Address - Street 1:1 SWINGLE STUDENT HEALTH SERVICE
Practice Address - Street 2:MONTANA STATE UNIVERSITY
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59717-3260
Practice Address - Country:US
Practice Address - Phone:406-994-2311
Practice Address - Fax:406-994-2504
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-02-08
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Provider Licenses
StateLicense IDTaxonomies
MT10813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0144781Medicaid
MT000084811Medicare ID - Type Unspecified
I35525Medicare UPIN