Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 30610 | AZ |
N | 207RN0300X | Nephrologist | 30610 | AZ |
NPI | 1295712172 |
---|---|
Provider Name | Dr. Marek J Mazur |
First Address | Phoenix, AZ 85054-4502 |
Second Address | Phoenix, AZ 85054-4502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 30/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
708935 | (05) | AZ |
86080015085259A812 | TRIWEST (01) | AZ |
H39467 | (02) |