Individual
DR. JERROD CARL MITZEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2485 12TH ST SE, SALEM, OR 97302-2151
(503) 363-8047
(503) 363-6571
Mailing address
2485 12TH ST SE, SALEM, OR 97302-2151
(503) 363-8047
(503) 363-6571
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
40749
AZ
207Q00000X
Family Medicine Physician
57010891
OH
207Q00000X
Family Medicine Physician
Primary
MD28732
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276275
—
OR
Enumeration date
06/15/2008
Last updated
04/06/2017
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