Individual
DR. MITCHELL DONGJUN IMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10647 BRAMBLECREST DR, AUSTIN, TX 78726-1906
(512) 906-1974
Mailing address
10647 BRAMBLECREST DR, AUSTIN, TX 78726-1906
(512) 906-1974
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
200200707
NC
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
200200707
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
131UT
BCBS NC
NC
01
—
7355461
AETNA
NC
05
—
89131UT
—
NC
01
—
D8866
MEDCOST
NC
Enumeration date
05/26/2006
Last updated
09/02/2008
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