Healthcare Provider Details

I. General information

NPI: 1356740930
Provider Name (Legal Business Name): MAZEN E ZAWAIDEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR STE 175
COEUR D ALENE ID
83814-4401
US

IV. Provider business mailing address

700 W IRONWOOD DR STE 175
COEUR D ALENE ID
83814-4401
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-6300
  • Fax: 208-625-6301
Mailing address:
  • Phone: 208-625-6309
  • Fax: 208-625-6310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberA184519
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberM-16135
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM-16135
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA184519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: