Provider Demographics
NPI:1932634961
Name:MITCHELL, JORDAN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:SCOTT
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 1:224 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029-3808
Mailing Address - Country:US
Mailing Address - Phone:806-935-7171
Mailing Address - Fax:
Practice Address - Street 1:1515 E 1ST ST STE 100
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-3575
Practice Address - Country:US
Practice Address - Phone:806-934-2983
Practice Address - Fax:806-934-2984
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXT0573207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program