Healthcare Provider Details

I. General information

NPI: 1306809918
Provider Name (Legal Business Name): MARK V MAZZIOTTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 08/29/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN ST CC650 00
HOUSTON TX
77030-2303
US

IV. Provider business mailing address

2 GREENWAY PLAZA SUITE 910
HOUSTON TX
77046
US

V. Phone/Fax

Practice location:
  • Phone: 832-822-3135
  • Fax: 832-825-3141
Mailing address:
  • Phone: 713-798-1750
  • Fax: 713-798-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberL2453
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMED-PHYS-LIC-100462
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number30540
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number75493
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: