Provider Demographics
NPI:1891864351
Name:MIZE, BRUCE F (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:F
Last Name:MIZE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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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
Practice Address - Street 2:SUITE 306
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8904
Practice Address - Country:US
Practice Address - Phone:805-614-9880
Practice Address - Fax:805-614-9881
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2010-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG16927207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G169270Medicaid
CA770514510OtherEIN
CAA39951Medicare UPIN
CA00G169270Medicaid