Provider Demographics
NPI:1578889127
Name:MIZE, TERRY (PA-C)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:MIZE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 TULANE PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2153
Mailing Address - Country:US
Mailing Address - Phone:770-364-1163
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF NEW MEXICO MSC09 5040
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-1000
Practice Address - Country:US
Practice Address - Phone:505-925-0857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005610363A00000X
NMPA2013-0012363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant