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General NPI Number Information
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NPI Number | 1497284731
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Entity Type | Individual
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Provider Name | MOSTAFA MOHAMED EZZAT HAMZA A MAZEN MD
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Gender | Male
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Dates
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Enumeration Date | 06/09/2017
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Last Update Date | 04/20/2023
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Provider Practice Location Address
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Address Line | 400 E 3RD ST
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City | DULUTH
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State | MN
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Zip | 55805-1951
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Country | US
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Telephone | 218-786-8364
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Fax |
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Provider Business Mailing Address
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Address Line | SSB-5 400 EAST THIRD STREET
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City | DULUTH
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State | MN
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Zip | 55805-1951
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Country | US
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Telephone | 218-786-8364
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Fax |
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD22505
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 2023011649
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 296424
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License Number State | NY
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