MEDICARE: JEFFREY M MAZURE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS-013105	PA
2	207Q00000X	Family Medicine Physician	MB74824	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CD4829	OTHER	PA	RR MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053351924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY M MAZURE DO

Provider Business Mailing Address
First Line	:	400 LAUREL OAK RD STE 105
Second Line	:
City	:	VOORHEES
State	:	NJ
Zip	:	08043-4455
Country	:	US
Telephone Number	:	856-922-9894
Fax Number	:	856-922-9890

Provider Business Practice Location Address
First Line	:	15 E REDMAN AVE STE A
Second Line	:
City	:	HADDONFIELD
State	:	NJ
Zip	:	08033-2316
Country	:	US
Telephone Number	:	856-428-1335
Fax Number	:	856-428-1330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	09/27/2019

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Directions to “ JEFFREY M MAZURE DO” Practice Location

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