Healthcare Provider Details

I. General information

NPI: 1033607858
Provider Name (Legal Business Name): ANITA MAZLOOM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 SPRING HILL AVE
MOBILE AL
36604-1405
US

IV. Provider business mailing address

PO BOX 40098
MOBILE AL
36640-0098
US

V. Phone/Fax

Practice location:
  • Phone: 251-665-8000
  • Fax: 251-665-8010
Mailing address:
  • Phone: 251-434-3473
  • Fax: 251-434-3757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD.42882
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: