Healthcare Provider Details

I. General information

NPI: 1881782001
Provider Name (Legal Business Name): JOSHUA EARL MIZELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 LAPALCO BLVD STE. 100
HARVEY LA
70058-2302
US

IV. Provider business mailing address

3909 LAPALCO BLVD STE. 100
HARVEY LA
70058-2302
US

V. Phone/Fax

Practice location:
  • Phone: 504-349-6900
  • Fax: 504-340-4305
Mailing address:
  • Phone: 504-349-6900
  • Fax: 504-340-4305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number204673
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: