Provider Demographics
NPI:1881782001
Name:MIZELL, JOSHUA EARL (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:EARL
Last Name:MIZELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3909 LAPALCO BLVD
Mailing Address - Street 2:STE. 100
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2302
Mailing Address - Country:US
Mailing Address - Phone:504-349-6900
Mailing Address - Fax:504-340-4305
Practice Address - Street 1:3909 LAPALCO BLVD
Practice Address - Street 2:STE. 100
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2302
Practice Address - Country:US
Practice Address - Phone:504-349-6900
Practice Address - Fax:504-340-4305
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2152483Medicaid
LA2152483Medicaid