Provider Demographics
NPI:1780613166
Name:MITCHELL, THOMAS C (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
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 1:1827 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-7605
Mailing Address - Country:US
Mailing Address - Phone:850-785-3799
Mailing Address - Fax:850-763-5456
Practice Address - Street 1:1827 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7605
Practice Address - Country:US
Practice Address - Phone:850-785-3799
Practice Address - Fax:850-763-5456
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80468207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35470ZMedicare ID - Type Unspecified
G20303Medicare UPIN