Organization
CRYSTAL BEACH MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE LEVER MITCHELL PA-C (MEMBER)
(409) 454-2543
Entity
Organization
Contact information
Practice address
955 S. EAST RD., CRYSTAL BEACH, TX 77650-1449
(409) 454-2543
(866) 521-5608
Mailing address
PO BOX 1449, CRYSTAL BEACH, TX 77650-1449
(409) 454-2543
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182389001
—
TX
05
—
182389002
—
TX
Enumeration date
07/21/2006
Last updated
01/13/2009
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