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General NPI Number Information
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NPI Number | 1578889127
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Entity Type | Individual
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Provider Name | TERRY MIZE PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/07/2010
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | UNIVERSITY OF NEW MEXICO MSC09 5040
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City | ALBUQUERQUE
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State | NM
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Zip | 87131-1000
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Country | US
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Telephone | 505-925-0857
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Fax |
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Provider Business Mailing Address
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Address Line | 335 TULANE PL NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2153
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Country | US
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Telephone | 770-364-1163
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 005610
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2013-0012
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License Number State | NM
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