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General NPI Number Information
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NPI Number | 1417265851
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Entity Type | Individual
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Provider Name | BRIAN CONFREY MAZZARELLA MD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 101 MEDICAL PKWY STE 200
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City | LAKEWAY
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State | TX
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Zip | 78738-5647
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Country | US
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Telephone | 512-263-0300
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Fax | 512-263-0316
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Provider Business Mailing Address
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Address Line | 8240 N MOPAC EXPY STE 100
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City | AUSTIN
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State | TX
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Zip | 78759-8869
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Country | US
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Telephone | 512-687-1950
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Fax | 512-407-9010
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD.207532
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | R5008
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License Number State | TX
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