Provider Demographics
NPI:1184005332
Name:MIRZA, DANISH (DO)
Entity type:Individual
Prefix:
First Name:DANISH
Middle Name:
Last Name:MIRZA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 NE 129TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-3324
Mailing Address - Country:US
Mailing Address - Phone:971-910-3090
Mailing Address - Fax:
Practice Address - Street 1:2805 NE 129TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3324
Practice Address - Country:US
Practice Address - Phone:971-910-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-13
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61505037207R00000X
ORDO185061207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine