| Mazzare Medical, Pllc | |
|
5380 Old Bullard Rd Ste 600-357 Tyler TX 75703-3607 | |
| (903) 245-3242 | |
| (877) 903-6204 |
| Full Name | Mazzare Medical, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5380 Old Bullard Rd Ste 600-357, Tyler, Texas |
| Authorized Official Name and Position | Mark Alan Mazzare (M.D./OWNER) |
| Authorized Official Contact | 9032453242 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mazzare Medical, Pllc 5380 Old Bullard Rd Ste 600-357 Tyler TX 75703-3607 Ph: (903) 245-3242 | Mazzare Medical, Pllc 5380 Old Bullard Rd Ste 600-357 Tyler TX 75703-3607 Ph: (903) 245-3242 |
| NPI Number | 1124390638 |
|---|---|
| Provider Enumeration Date | 01/30/2012 |
| Last Update Date | 01/27/2017 |
| Medicare PECOS PAC ID | 4587828066 |
|---|---|
| Medicare Enrollment ID | O20120613000388 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124390638 | NPI | - | NPPES |
| 299868401 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | K3331 (Texas) | Primary |
| Provider Name | Mark A Mazzare |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891769709 PECOS PAC ID: 6204890775 Enrollment ID: I20041115000721 |
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