Healthcare Provider Details

I. General information

NPI: 1740383652
Provider Name (Legal Business Name): ROBY DAN MIZE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 WALNUT HILL LN SUITE 418, LB 37
DALLAS TX
75231-4405
US

IV. Provider business mailing address

8210 WALNUT HILL LN SUITE 418, LB 37
DALLAS TX
75231-4405
US

V. Phone/Fax

Practice location:
  • Phone: 214-484-7912
  • Fax: 214-484-7912
Mailing address:
  • Phone: 214-484-7912
  • Fax: 214-484-7912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE0559
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: