Provider Demographics
NPI:1164422127
Name:MITCHELL, EDMUND M I (MD)
Entity type:Individual
Prefix:
First Name:EDMUND
Middle Name:M
Last Name:MITCHELL
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350-0617
Mailing Address - Country:US
Mailing Address - Phone:928-662-0406
Mailing Address - Fax:928-662-0407
Practice Address - Street 1:950 E MAIN ST BLDG B
Practice Address - Street 2:
Practice Address - City:SOMERTON
Practice Address - State:AZ
Practice Address - Zip Code:85350-7409
Practice Address - Country:US
Practice Address - Phone:928-236-8001
Practice Address - Fax:928-627-1509
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ43534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F64050Medicare UPIN
0844551Medicare ID - Type Unspecified