Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME55536 | FL |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | ME55536 | FL |
NPI | 1225049752 |
---|---|
Provider Name | Dr. John M. Mazur |
First Address | Jacksonville, FL 32216-4374 |
Second Address | Jacksonville, FL 32216-4374 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 12/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000446619A | (05) | GA |
61888800 | (05) | FL |
D09944 | (02) |