Provider Demographics
NPI:1699728477
Name:MITCHELL, PAUL RAYMOND (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RAYMOND
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 1:15 MOSS CREEK VLG
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1105
Mailing Address - Country:US
Mailing Address - Phone:843-415-8511
Mailing Address - Fax:800-820-0148
Practice Address - Street 1:15 MOSS CREEK VLG
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-1105
Practice Address - Country:US
Practice Address - Phone:843-415-8511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC00666208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC006665Medicaid
SCH58380Medicare UPIN