Healthcare Provider Details

I. General information

NPI: 1659357192
Provider Name (Legal Business Name): JAMES MIZE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 13TH AVE SE
DECATUR AL
35601-4306
US

IV. Provider business mailing address

1225 13TH AVE SE
DECATUR AL
35601-4306
US

V. Phone/Fax

Practice location:
  • Phone: 256-350-0675
  • Fax: 256-350-1046
Mailing address:
  • Phone: 256-350-0675
  • Fax: 256-350-1046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAL04393
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: