Provider Demographics
NPI:1750373700
Name:MITCHELL, RODGER (MD)
Entity type:Individual
Prefix:DR
First Name:RODGER
Middle Name:
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 1:605 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010
Mailing Address - Country:US
Mailing Address - Phone:817-272-2773
Mailing Address - Fax:817-272-2744
Practice Address - Street 1:605 S WEST ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010
Practice Address - Country:US
Practice Address - Phone:817-272-2773
Practice Address - Fax:817-272-2744
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4359207Q00000X
WV22412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK5842Medicaid
TX82G884OtherBCBS
TX80849ZOtherHMO BLUE
NMA110OtherTRIWEST
TX80849ZOtherHMO BLUE
TX82G884Medicare ID - Type Unspecified