Provider Demographics
NPI:1497848089
Name:MITCHELL, CHARLIE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:CHARLIE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10510 SAGETRAIL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-2912
Mailing Address - Country:US
Mailing Address - Phone:281-484-1167
Mailing Address - Fax:281-484-2570
Practice Address - Street 1:2002 HOLCOMBE BOULEVARD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4298
Practice Address - Country:US
Practice Address - Phone:713-794-1414
Practice Address - Fax:713-794-7094
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA0849363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical