Individual
MARC E MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5100
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2680
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
11840
MS
2086S0129X
Vascular Surgery Physician
Primary
11840
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08058025
—
MS
01
—
P00638452
RAILROAD MEDICARE
MS
Enumeration date
10/13/2006
Last updated
04/02/2015
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