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NPI Code Detail

MEDICARE: JOHN LOUIS MAZZELLA MD

MEDICARE: JOHN LOUIS MAZZELLA MD
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
12085R0202XDiagnostic Radiology PhysicianME89003FL

Other Identifiers

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

General Provider Information

NPI Number : 1588610026
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN LOUIS MAZZELLA MD
Provider Business Mailing Address
First Line : PO BOX 161180
Second Line :
City : ALTAMONTE SPRINGS
State : FL
Zip : 32716-1180
Country : US
Telephone Number : 904-388-6949
Fax Number : 904-388-1841
Provider Business Practice Location Address
First Line : 4201 BELFORT RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-1431
Country : US
Telephone Number : 904-296-3886
Fax Number : 904-551-0709
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2006
Last Update Date : 08/14/2023

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