Healthcare Provider Details

I. General information

NPI: 1598956740
Provider Name (Legal Business Name): DAVID L MIZE SR. AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4065 CAPITAL DR
ROCKY MOUNT NC
27804-3123
US

IV. Provider business mailing address

4065 CAPITAL DR
ROCKY MOUNT NC
27804-3123
US

V. Phone/Fax

Practice location:
  • Phone: 252-977-4327
  • Fax: 252-977-4329
Mailing address:
  • Phone: 252-977-4327
  • Fax: 252-977-4329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1021
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number411
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: