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General NPI Number Information
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NPI Number | 1619207883
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Entity Type | Organization
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Legal Business Name | JENNIFER BETH MAZER, M.D., P.A.
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 2714 N. UNIVERSITY DR. SUITE 100
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City | NACOGDOCHES
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State | TX
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Zip | 75965
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Country | US
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Telephone | 936-564-4446
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Fax |
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Provider Business Mailing Address
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Address Line | 2714 N. UNIVERSITY DR. SUITE 100
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City | NACOGDOCHES
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State | TX
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Zip | 75965
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Country | US
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Telephone | 936-564-4446
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JENNIFER BETH MAZER
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Credential |
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Telephone | 936-564-4446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | L5043
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License Number State | TX
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