Provider Demographics
NPI:1932113735
Name:MITCHELL, BAKER A III (MD)
Entity type:Individual
Prefix:
First Name:BAKER
Middle Name:A
Last Name:MITCHELL
Suffix:III
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 1:345 FLATWOODS FOREST LOOP
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-8843
Mailing Address - Country:US
Mailing Address - Phone:210-884-3779
Mailing Address - Fax:
Practice Address - Street 1:100 N RICHARD JACKSON BLVD STE 120
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407
Practice Address - Country:US
Practice Address - Phone:850-226-6801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254963207L00000X
TXP1108207L00000X, 207LP2900X
FLME134995207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286138701Medicaid
TX286138701Medicaid