Provider Demographics
NPI:1174548366
Name:MIZELL, PHILIP LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:LEWIS
Last Name:MIZELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9601 LILE DR
Mailing Address - Street 2:SUITE 1050
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6321
Mailing Address - Country:US
Mailing Address - Phone:501-228-7400
Mailing Address - Fax:501-537-7412
Practice Address - Street 1:9601 LILE DR
Practice Address - Street 2:SUITE 1050
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-228-7400
Practice Address - Fax:501-537-7412
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC54292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105083001Medicaid
AR53716Medicare PIN
AR105083001Medicaid