Provider Demographics
NPI:1780452987
Name:MIZER, JEFFREY R
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:MIZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19778 STATE ROUTE 16
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-8966
Mailing Address - Country:US
Mailing Address - Phone:740-402-1144
Mailing Address - Fax:
Practice Address - Street 1:19778 STATE ROUTE 16
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-8966
Practice Address - Country:US
Practice Address - Phone:740-402-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health