Provider Demographics
NPI:1437359734
Name:BRUCE F. MIZE, M.D., INC.
Entity Type:Organization
Organization Name:BRUCE F. MIZE, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:MIZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-614-9880
Mailing Address - Street 1:116 S PALISADE DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8904
Mailing Address - Country:US
Mailing Address - Phone:805-614-9880
Mailing Address - Fax:805-614-9881
Practice Address - Street 1:116 S PALISADE DR STE 306
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8906
Practice Address - Country:US
Practice Address - Phone:805-614-9880
Practice Address - Fax:805-614-9881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16927207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G169270Medicaid
CAW15844Medicare PIN
CA00G169270Medicaid