Provider Demographics
NPI:1235117466
Name:MITCHELL, PHILLIP R (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:R
Last Name:MITCHELL
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 1:3020 KELLER BEND RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-6521
Mailing Address - Country:US
Mailing Address - Phone:865-690-6909
Mailing Address - Fax:
Practice Address - Street 1:3020 KELLER BEND RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-6521
Practice Address - Country:US
Practice Address - Phone:865-690-6909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19432207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN86250OtherBLUE CROSS
TN050011300OtherMCRR
TN86250OtherBLUECARE
TN100020622OtherPHP TENNCARE
TN86250OtherBLUE CROSS
TN050011300OtherMCRR
TN100020622OtherPHP TENNCARE