Healthcare Provider Details

I. General information

NPI: 1730204306
Provider Name (Legal Business Name): ELLIOT EUGENE MAZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 FRANKLIN BLVD SUITE 1020
SACRAMENTO CA
95823-1820
US

IV. Provider business mailing address

5208 TAMSEN CT
CARMICHAEL CA
95608-6036
US

V. Phone/Fax

Practice location:
  • Phone: 916-424-8412
  • Fax: 916-424-3249
Mailing address:
  • Phone: 916-485-8522
  • Fax: 916-485-0144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberG25949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: