Provider Demographics
NPI:1790776326
Name:MIZE, WILLIAM LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LAWRENCE
Last Name:MIZE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:PROVIDER ENROLLMENT -- RT. 1022
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-5302
Mailing Address - Country:US
Mailing Address - Phone:409-747-7334
Mailing Address - Fax:409-747-8579
Practice Address - Street 1:400 HARBORSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0001
Practice Address - Country:US
Practice Address - Phone:409-747-7334
Practice Address - Fax:409-747-8579
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060385A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R518Medicare PIN
INC90569Medicare UPIN
TX8K2204Medicare PIN