Healthcare Provider Details

I. General information

NPI: 1659758472
Provider Name (Legal Business Name): ALYSSA MIZE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALYSSA LOGSDON MD

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N LEE AVE
OKLAHOMA CITY OK
73102-1036
US

IV. Provider business mailing address

PO BOX 21228
TULSA OK
74121-1228
US

V. Phone/Fax

Practice location:
  • Phone: 800-841-4236
  • Fax:
Mailing address:
  • Phone: 8-414-2368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number32296
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: