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General NPI Number Information
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NPI Number | 1205075900
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Entity Type | Organization
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Legal Business Name | IDA MAZZONE MD PA
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 6101 PINE RIDGE RD
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City | NAPLES
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State | FL
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Zip | 34119-3900
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Country | US
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Telephone | 239-348-4400
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Fax | 239-236-1300
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Provider Business Mailing Address
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Address Line | 2338 IMMOKALEE RD #149
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City | NAPLES
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State | FL
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Zip | 34110-1445
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Country | US
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Telephone | 239-465-9722
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Fax | 239-236-1300
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Authorized Official
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Title or Position | PRESIDENT
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Name | IDA MAZZONE
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Credential | MD
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Telephone | 239-465-9722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME74663
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License Number State | FL
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