Provider Demographics
NPI:1578805149
Name:MITCHELL, CLIFF LAWRENCE (DVM)
Entity Type:Individual
Prefix:
First Name:CLIFF
Middle Name:LAWRENCE
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:191 WEST 100 NORTH
Mailing Address - City:RICHMOND
Mailing Address - State:UT
Mailing Address - Zip Code:84333-0088
Mailing Address - Country:US
Mailing Address - Phone:435-258-2190
Mailing Address - Fax:435-258-2489
Practice Address - Street 1:191 W 100 N
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:UT
Practice Address - Zip Code:84333-1404
Practice Address - Country:US
Practice Address - Phone:435-258-2190
Practice Address - Fax:435-258-2489
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4984060-2801174M00000X
IDV-3255174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian