Provider Demographics
NPI:1477525848
Name:MITCHELL, BARRY J (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:J
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1616 S KELLY AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3651
Mailing Address - Country:US
Mailing Address - Phone:405-330-0032
Mailing Address - Fax:405-715-8888
Practice Address - Street 1:1616 S KELLY AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3651
Practice Address - Country:US
Practice Address - Phone:405-330-0032
Practice Address - Fax:405-715-8888
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100222470BMedicaid
OK080168970OtherRAILROAD MEDICARE
OKD35055Medicare UPIN