Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 057638 | OH |
Y | 213ES0103X | Foot & Ankle Surgery | 310 | OK |
NPI | 1083901367 |
---|---|
Provider Name | Dr. Gregory Alan Mazur |
First Address | Fort Myers, FL 33908-2670 |
Second Address | Naples, FL 34108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2011 |
Last Update Date | 25/10/2018 |