Healthcare Provider Details

I. General information

NPI: 1174548366
Provider Name (Legal Business Name): PHILIP LEWIS MIZELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 LILE DR SUITE 1050
LITTLE ROCK AR
72205-6321
US

IV. Provider business mailing address

9601 LILE DR SUITE 1050
LITTLE ROCK AR
72205-6321
US

V. Phone/Fax

Practice location:
  • Phone: 501-228-7400
  • Fax: 501-537-7412
Mailing address:
  • Phone: 501-228-7400
  • Fax: 501-537-7412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC5429
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: