Provider Demographics
NPI:1447230685
Name:MITCHELL, DERRICK A (MD)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:A
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 1:10130 LOUETTA RD
Mailing Address - Street 2:SUITE L
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-2118
Mailing Address - Country:US
Mailing Address - Phone:281-301-3130
Mailing Address - Fax:281-301-3134
Practice Address - Street 1:10130 LOUETTA RD
Practice Address - Street 2:SUITE L
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-2118
Practice Address - Country:US
Practice Address - Phone:281-301-3130
Practice Address - Fax:281-301-3134
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0828207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J9907OtherBCBSTX PROV NO
TX175406101Medicaid
TXP00251027OtherRAILROAD MEDICARE PROV NO
TX175406102Medicaid
TX8D7510Medicare ID - Type UnspecifiedMCARE PROV NO
TXP00251027OtherRAILROAD MEDICARE PROV NO
TXI35313Medicare UPIN