Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | ME145595 | FL |
Y | 207ND0101X | MOHS-Micrographic Surgeon | ME145595 | FL |
N | 207NS0135X | Procedural Dermatology | ME145595 | FL |
NPI | 1518256932 |
---|---|
Provider Name | Dr. Sean Mazloom |
First Address | Venice, FL 34292-2465 |
Second Address | Venice, FL 34292-1651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2011 |
Last Update Date | 03/11/2021 |