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General NPI Number Information
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NPI Number | 1376719781
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Entity Type | Individual
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Provider Name | MATTHEW A MAZUR D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 12/23/2020
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Provider Practice Location Address
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Address Line | 829 N CENTER AVE SUITE 140
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City | GAYLORD
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State | MI
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Zip | 49735-1595
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Country | US
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Telephone | 989-731-7870
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Fax | 989-731-7837
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Provider Business Mailing Address
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Address Line | 850 N OTSEGO AVE SUITE 1
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City | GAYLORD
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State | MI
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Zip | 49735-1568
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Country | US
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Telephone | 989-731-7708
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Fax | 989-731-7929
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 036119681
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 510102814
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License Number State | MI
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