Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | Q7421 | TX |
Y | 111NI0900X | Internist | Q7421 | TX |
N | 207RG0300X | Geriatric Medicine | Q7421 | TX |
NPI | 1124374186 |
---|---|
Provider Name | Haitham Mazek |
First Address | Lubbock, TX 79430-0002 |
Second Address | Lubbock, TX 79415-3364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2012 |
Last Update Date | 07/04/2021 |