Individual
DR. DEREK JAMES MITZEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
18205 N 51ST AVE, SUITE 109, GLENDALE, AZ 85308-1490
(602) 547-1400
(602) 547-1401
Mailing address
18205 N 51ST AVE, SUITE 109, GLENDALE, AZ 85308-1490
(602) 547-1400
(602) 547-1401
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
4296
AZ
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
4296
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116627
—
AZ
01
—
Z115507
MEDICARE ID
—
Enumeration date
05/23/2006
Last updated
05/27/2008
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