Provider Demographics
NPI:1871565457
Name:MAZUREK, DAVID G (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:MAZUREK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:300 STEAM PLANT RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3032
Mailing Address - Country:US
Mailing Address - Phone:615-230-8070
Mailing Address - Fax:615-452-1774
Practice Address - Street 1:300 STEAM PLANT RD
Practice Address - Street 2:SUITE 300
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3032
Practice Address - Country:US
Practice Address - Phone:615-230-8070
Practice Address - Fax:615-452-1774
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD39579207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3329094Medicaid
TNF56635Medicare UPIN
TN3329094Medicare ID - Type Unspecified