Provider Demographics
NPI:1669611141
Name:MITCHELL, GORDON RAY (HIS)
Entity type:Individual
Prefix:MR
First Name:GORDON
Middle Name:RAY
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5303 50TH STREET
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-5823
Mailing Address - Country:US
Mailing Address - Phone:806-799-8950
Mailing Address - Fax:806-792-9404
Practice Address - Street 1:1541 J.B.S PARKWAY
Practice Address - Street 2:#1
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79701
Practice Address - Country:US
Practice Address - Phone:432-363-9566
Practice Address - Fax:432-362-0977
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50621237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist