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General NPI Number Information
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NPI Number | 1497089478
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Entity Type | Organization
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Legal Business Name | SAMUEL R MITZ MD PA
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Dates
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Enumeration Date | 09/24/2009
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Last Update Date | 02/25/2014
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Provider Practice Location Address
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Address Line | 2201 W LAMPASAS ST
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City | ENNIS
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State | TX
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Zip | 75119-5644
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Country | US
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Telephone | 972-875-0900
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Fax | 469-256-2163
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Provider Business Mailing Address
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Address Line | PO BOX 4781
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City | DALLAS
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State | TX
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Zip | 75208-0781
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Country | US
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Telephone | 972-875-0900
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Fax | 214-942-8625
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAMUEL R MITZ
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Credential | MD
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Telephone | 972-875-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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