Provider Demographics
NPI:1477673804
Name:MICKELSON, STEVEN DON (PA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:DON
Last Name:MICKELSON
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Gender:M
Credentials:PA
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Mailing Address - Street 1:7800 SHOAL CREEK BLVD
Mailing Address - Street 2:STE 205-N
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1098
Mailing Address - Country:US
Mailing Address - Phone:512-206-4300
Mailing Address - Fax:512-206-4376
Practice Address - Street 1:1900 SCENIC DR
Practice Address - Street 2:SUITE 3308
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7724
Practice Address - Country:US
Practice Address - Phone:512-930-1105
Practice Address - Fax:512-869-7434
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2022-02-09
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Provider Licenses
StateLicense IDTaxonomies
TXPA05217363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J8379Medicare PIN