Individual
DR. KELLY T. MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3601 4TH ST, 2A100, LUBBOCK, TX 79430-0002
(806) 743-2020
(806) 743-1782
Mailing address
PO BOX 5865, LUBBOCK, TX 79408-5865
(806) 743-2898
(806) 743-2787
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
L1942
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08534730
—
NM
01
—
101449100
FIRSTCARE COMMERCIAL
TX
05
—
101449101
—
TX
05
—
144792205
—
TX
05
—
144792206
—
TX
05
—
200013870A
—
OK
01
—
81940
PRESBYTERIAN COMMERCIAL
NM
05
—
81940
—
NM
01
—
87410Z
HMO BLUE
TX
01
—
8G7982
BC/BS
TX
01
—
A582
TRIWEST
NM
Enumeration date
10/31/2005
Last updated
01/06/2014
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