Provider Demographics
NPI:1124028303
Name:MIZELL, JAMES CAGLE (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CAGLE
Last Name:MIZELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620E 117TH S ST
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008
Mailing Address - Country:US
Mailing Address - Phone:918-269-1085
Mailing Address - Fax:918-299-6520
Practice Address - Street 1:6620E 117TH S ST
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008
Practice Address - Country:US
Practice Address - Phone:918-269-1085
Practice Address - Fax:918-299-6520
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100099720AMedicaid
OK241426002Medicare ID - Type Unspecified
OK100099720AMedicaid