Provider Demographics
NPI:1689672271
Name:MITCHELL, WILLIAM CLARK (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CLARK
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4501 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MC KINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1651
Mailing Address - Country:US
Mailing Address - Phone:972-548-8195
Mailing Address - Fax:972-548-8866
Practice Address - Street 1:4501 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MC KINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1651
Practice Address - Country:US
Practice Address - Phone:972-548-8195
Practice Address - Fax:972-548-8866
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF9835208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8K4514Medicare PIN
TXE21051Medicare UPIN