Provider Demographics
NPI:1396903670
Name:MITCHELL, ROBERT BEN (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BEN
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 W BROWARD BLVD STE 203-2008
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-1314
Mailing Address - Country:US
Mailing Address - Phone:786-262-5750
Mailing Address - Fax:
Practice Address - Street 1:143 SW 22ND TER
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1444
Practice Address - Country:US
Practice Address - Phone:786-262-5750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7690208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice