Provider Demographics
NPI:1992770796
Name:MITCHELL, CHRISTOPHER MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MATTHEW
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1705 WEST GENTRY AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHECOTAH
Mailing Address - State:OK
Mailing Address - Zip Code:74426
Mailing Address - Country:US
Mailing Address - Phone:918-473-4989
Mailing Address - Fax:
Practice Address - Street 1:3019 DENVER ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5353
Practice Address - Country:US
Practice Address - Phone:918-686-6551
Practice Address - Fax:918-686-6633
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK22526207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH98907Medicare UPIN