Provider Demographics
NPI:1922211606
Name:MUTZIG, ELIZABETH MONTEZ (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MONTEZ
Last Name:MUTZIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1260 E 27TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-3918
Mailing Address - Country:US
Mailing Address - Phone:918-743-9696
Mailing Address - Fax:918-743-9696
Practice Address - Street 1:1260 E 27TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-3918
Practice Address - Country:US
Practice Address - Phone:918-743-9696
Practice Address - Fax:918-743-9696
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16940207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE86455Medicare UPIN