Provider Demographics
NPI:1154393916
Name:MAJOR, MITCHELL ANDREW (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:ANDREW
Last Name:MAJOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 EVERGREEN LN
Mailing Address - Street 2:#8
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7928
Mailing Address - Country:US
Mailing Address - Phone:928-537-6977
Mailing Address - Fax:928-537-9581
Practice Address - Street 1:2051 EVERGREEN LN
Practice Address - Street 2:#8
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7928
Practice Address - Country:US
Practice Address - Phone:928-537-6977
Practice Address - Fax:928-537-9581
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30101207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ646523Medicaid
AZ646523Medicaid
69639Medicare ID - Type Unspecified