Individual
JACOB MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1000 SE UGLOW AVE, DALLAS, OR 97338-2645
(503) 623-8376
Mailing address
PO BOX 13129, SALEM, OR 97309-1129
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA195749
OR
Other
Enumeration date
06/25/2018
Last updated
03/26/2020
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