Provider Demographics
NPI:1952595738
Name:RAYFORD B. MITCHELL M.D., P.A.
Entity Type:Organization
Organization Name:RAYFORD B. MITCHELL M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYFORD
Authorized Official - Middle Name:BENARD
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-583-3900
Mailing Address - Street 1:3349 S HIGHWAY 181
Mailing Address - Street 2:SUITE 3
Mailing Address - City:KENEDY
Mailing Address - State:TX
Mailing Address - Zip Code:78119-5268
Mailing Address - Country:US
Mailing Address - Phone:830-583-3900
Mailing Address - Fax:830-583-3903
Practice Address - Street 1:3349 S HIGHWAY 181
Practice Address - Street 2:SUITE 3
Practice Address - City:KENEDY
Practice Address - State:TX
Practice Address - Zip Code:78119-5240
Practice Address - Country:US
Practice Address - Phone:830-583-3900
Practice Address - Fax:830-583-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190956601Medicaid
TX0090PVOtherBC/BS TEXAS
TXDH1608Medicare PIN
TX00Y151Medicare PIN