Provider Demographics
NPI:1447253844
Name:MAZOUR, DANIEL E (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:MAZOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:121 15TH AVE
Mailing Address - Street 2:PO BOX 315
Mailing Address - City:FRANKLIN
Mailing Address - State:NE
Mailing Address - Zip Code:68939-1043
Mailing Address - Country:US
Mailing Address - Phone:308-425-6249
Mailing Address - Fax:308-425-3164
Practice Address - Street 1:121 15TH AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NE
Practice Address - Zip Code:68939-1043
Practice Address - Country:US
Practice Address - Phone:308-425-6249
Practice Address - Fax:308-425-3164
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE17878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E28308Medicare UPIN