Healthcare Provider Details

I. General information

NPI: 1053351924
Provider Name (Legal Business Name): JEFFREY M MAZURE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E REDMAN AVE STE A
HADDONFIELD NJ
08033-2316
US

IV. Provider business mailing address

400 LAUREL OAK RD STE 105
VOORHEES NJ
08043-4455
US

V. Phone/Fax

Practice location:
  • Phone: 856-428-1335
  • Fax: 856-428-1330
Mailing address:
  • Phone: 856-922-9894
  • Fax: 856-922-9890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS-013105
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB74824
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: