Individual
MR. THADDEUS DWAYNE MITCHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
36TH MEDICAL GROUP, UNIT 14010 BLDG 26012, ANDERSEN AFB, GU 96543-4003
(671) 366-4549
Mailing address
36TH MEDICAL GROUP, UNIT 14010 BLDG 26012, ANDERSEN AFB, GU 96543-4003
(671) 366-4549
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
12/11/2015
Last updated
08/14/2024
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