Provider Demographics
NPI:1043296189
Name:DAVID MAZER,M.D.,P.A.
Entity type:Organization
Organization Name:DAVID MAZER,M.D.,P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-805-9503
Mailing Address - Street 1:PO BOX 950699
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32795-0699
Mailing Address - Country:US
Mailing Address - Phone:407-805-9503
Mailing Address - Fax:321-396-7711
Practice Address - Street 1:1414 KUHL AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2008
Practice Address - Country:US
Practice Address - Phone:407-805-9503
Practice Address - Fax:321-396-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266648100Medicaid
FL266648100Medicaid