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NPI Code Detail

MEDICARE: ROGER DAVID MIZE MD

MEDICARE: ROGER DAVID MIZE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician22253GA

General Provider Information

NPI Number : 1265439574
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER DAVID MIZE MD
Provider Business Mailing Address
First Line : 109 COLLEGE AVE
Second Line :
City : ELBERTON
State : GA
Zip : 30635-1705
Country : US
Telephone Number : 706-283-3315
Fax Number : 706-283-2159
Provider Business Practice Location Address
First Line : 109 COLLEGE AVE
Second Line :
City : ELBERTON
State : GA
Zip : 30635-1705
Country : US
Telephone Number : 706-283-3315
Fax Number : 706-283-2159
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2005
Last Update Date : 01/05/2010

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