Individual
MR. MARK EDWARD MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2960 TONGASS AVENUE, KETCHIKAN, AK 99901-5742
(907) 228-4900
(800) 852-3264
Mailing address
2960 TONGASS AVENUE, KETCHIKAN, AK 99901-5742
(907) 228-4900
(800) 852-3264
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2681761205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
314804
—
AZ
05
—
52588084
—
NM
05
—
82071365
—
CO
05
—
D0289
—
UT
Enumeration date
03/24/2006
Last updated
07/01/2016
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