Provider Demographics
NPI:1699104620
Name:MITCH P. FEARING MD, PA
Entity type:Organization
Organization Name:MITCH P. FEARING MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:FEARING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-462-1327
Mailing Address - Street 1:14819 NW 140TH ST
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-2600
Mailing Address - Country:US
Mailing Address - Phone:386-462-1327
Mailing Address - Fax:386-462-1328
Practice Address - Street 1:14819 NW 140TH ST
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-2600
Practice Address - Country:US
Practice Address - Phone:386-462-1327
Practice Address - Fax:386-462-1328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51798261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1982646642OtherNPI