Healthcare Provider Details

I. General information

NPI: 1750484838
Provider Name (Legal Business Name): DAMIAN N MIZERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 S BONAVENTURE AVE STE 3
TRINIDAD CO
81082-2086
US

IV. Provider business mailing address

410 BENEDICTA AVE
TRINIDAD CO
81082-2093
US

V. Phone/Fax

Practice location:
  • Phone: 719-845-4296
  • Fax: 719-846-8285
Mailing address:
  • Phone: 719-846-9213
  • Fax: 719-846-8285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDR.0060695
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2006024365
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: