Provider Demographics
NPI:1760592695
Name:MITCHELL, ISAAC L (MD)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:L
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4121 W HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-1170
Practice Address - Country:US
Practice Address - Phone:850-914-7060
Practice Address - Fax:850-914-7065
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME86763207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71676OtherBLUE CROSS OF FLA
FLP00058125OtherMEDICARE RAILROAD
FLU0574ZMedicare PIN
FLH78396Medicare UPIN