Basic Information
| Provider Information | |||||||||
| NPI: | 1184005332 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIRZA | ||||||||
| FirstName: | DANISH | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13129 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973091129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038147557 | ||||||||
| FaxNumber: | 5038147560 | ||||||||
| Practice Location | |||||||||
| Address1: | 890 OAK ST SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035615200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2015 | ||||||||
| LastUpdateDate: | 12/20/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | DO185061 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.