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NPI Code Detail

MEDICARE: DR. EDWARD LAWRENCE MAZUCHOWSKI II M.D.,PH.D.

MEDICARE: DR. EDWARD LAWRENCE MAZUCHOWSKI II M.D.,PH.D.
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician01057843AIN
2207ZF0201XForensic Pathology Physician01057843AIN

General Provider Information

NPI Number : 1417009010
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWARD LAWRENCE MAZUCHOWSKI II M.D.,PH.D.
Provider Business Mailing Address
First Line : 3551 ROGER BROOKE DR
Second Line :
City : FORT SAM HOUSTON
State : TX
Zip : 78234-4504
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3551 ROGER BROOKE DR
Second Line :
City : FORT SAM HOUSTON
State : TX
Zip : 78234
Country : US
Telephone Number : 210-539-8774
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2007
Last Update Date : 10/07/2019

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