Healthcare Provider Details

I. General information

NPI: 1801908918
Provider Name (Legal Business Name): ANNA E MIZE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 HUMPHREYS BLVD
MEMPHIS TN
38120
US

IV. Provider business mailing address

PO BOX 1000 DEPT 34
MEMPHIS TN
38148
US

V. Phone/Fax

Practice location:
  • Phone: 901-383-8860
  • Fax: 901-383-8985
Mailing address:
  • Phone: 901-383-8860
  • Fax: 901-383-8985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number13287
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: