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Individual
TEDDY LEE MITCHELL
Active
Individual
TEDDY LEE MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
H4561
TX
207RS0010X
Sports Medicine (Internal Medicine) Physician
H4561
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110243668
RAILROAD MEDICARE
TX
01
—
840517
BLUE CROSS
TX
Enumeration date
12/08/2006
Last updated
01/25/2022
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