Individual
MAJOR JOSEPH MITTENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
12091 BRICKSOME AVE, BATON ROUGE, LA 70816-2699
(225) 756-2673
Mailing address
15960 HIGHLAND RD, BATON ROUGE, LA 70810-6512
(225) 752-2276
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
A10250
LA
Other
Enumeration date
05/04/2009
Last updated
05/04/2009
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