Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 30540 | OK |
Y | 2086S0120X | Pediatric Surgery | L2453 | TX |
N | 2086S0120X | Pediatric Surgery | MED-PHYS-LIC-100462 | MT |
NPI | 1306809918 |
---|---|
Provider Name | Mark V Mazziotti |
First Address | Houston, TX 77046 |
Second Address | Kalispell, MT 59901-3153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 08/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
112545202 | (05) | TX |
154947902 | (05) | TX |
200122410A | (05) | OK |
G08927 | (02) |