Provider Demographics
NPI:1902151970
Name:MIZELLE, ELIZABETH L (DO)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:L
Last Name:MIZELLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:T
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4501 CARTWRIGHT RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3537
Mailing Address - Country:US
Mailing Address - Phone:832-987-1758
Mailing Address - Fax:989-257-0675
Practice Address - Street 1:4501 CARTWRIGHT RD STE 104
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3537
Practice Address - Country:US
Practice Address - Phone:832-987-1758
Practice Address - Fax:989-257-0675
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0098207Q00000X
NC2015-00659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine