Healthcare Provider Details

I. General information

NPI: 1619079795
Provider Name (Legal Business Name): NAVEED JAVAID MIRZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 B WEST BUSINESS HWY 60
DEXTER MO
63841
US

IV. Provider business mailing address

1008 N MAIN ST
SIKESTON MO
63801-5044
US

V. Phone/Fax

Practice location:
  • Phone: 573-625-7149
  • Fax: 573-614-5806
Mailing address:
  • Phone: 573-471-1600
  • Fax: 573-472-7423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2006001560
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: