Provider Demographics
NPI:1669452975
Name:MITCHELL, ROBERT EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EUGENE
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 1:695 HILL COUNTRY DR STE B
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6074
Mailing Address - Country:US
Mailing Address - Phone:830-257-2880
Mailing Address - Fax:830-257-8333
Practice Address - Street 1:695 HILL COUNTRY DR
Practice Address - Street 2:SUITE B
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6076
Practice Address - Country:US
Practice Address - Phone:830-257-2880
Practice Address - Fax:830-257-8333
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9833174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1204414-02Medicaid
TXB95692Medicare UPIN
TX6143190001Medicare NSC