Mitcham, Thaddeus Dwayne

Mitcham, Thaddeus Dwayne is an individual health care provider with primary practice located at 354 Medical Group 2630 Central Ave, Eielson Afb AK 99702-2301. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Mitcham, Thaddeus Dwayne can be contacted via phone (907) 377-6127.

Contact Information

Primary practice address
354 Medical Group 2630 Central Ave Eielson Afb AK 99702-2301
Phone: (907) 377-6127
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X

Profile Details

NPI number 1497120760
LBN Legal business name Mitcham, Thaddeus Dwayne
Credentials PHYSICIAN ASSISTANT
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 11th, 2015
Last updated Aug 18th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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