Individual
JONATHAN CHRISTOPHER MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11102 SUNRISE BLVD E, SUITE 110, PUYALLUP, WA 98374-8846
(253) 697-7350
(253) 841-5962
Mailing address
PO BOX 40, PUYALLUP, WA 98371-0137
(253) 697-5502
(253) 697-5510
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD00041368
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0141390
L & I PROVIDER NUMBER
WA
01
—
1121MI
REGENCE RIDER NUMBER
WA
01
—
7699536
AETNA PROVIDER NUMBER
WA
05
—
8316432
—
WA
01
—
911203494BX
KPS PROVIDER NUMBER
WA
01
—
98375E004
TRICARE PROVIDER NUMBER
WA
Enumeration date
06/07/2006
Last updated
12/07/2011
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