Provider Demographics
NPI:1760605539
Name:MITCHELL, ALFRED TENNYSON (MD)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:TENNYSON
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:18100 ST. JOHN DRIVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NASSAU BAY
Mailing Address - State:TX
Mailing Address - Zip Code:77058
Mailing Address - Country:US
Mailing Address - Phone:281-335-0003
Mailing Address - Fax:281-335-0333
Practice Address - Street 1:18100 SAINT JOHN DR
Practice Address - Street 2:SUITE 220
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3631
Practice Address - Country:US
Practice Address - Phone:281-335-0003
Practice Address - Fax:281-335-0333
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ92142082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH12915Medicare UPIN