Healthcare Provider Details

I. General information

NPI: 1750461901
Provider Name (Legal Business Name): BARBARA JUNE VIZE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 MEMORIAL DR
SPRING VALLEY MN
55975-1024
US

IV. Provider business mailing address

802 MEMORIAL DR
SPRING VALLEY MN
55975-1024
US

V. Phone/Fax

Practice location:
  • Phone: 507-346-7373
  • Fax:
Mailing address:
  • Phone: 507-346-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39262
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: