MEDICARE: DR. DAVID KEITH MAZER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	ME74014	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033195870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID KEITH MAZER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 950699
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32795-0699
Country	:	US
Telephone Number	:	407-805-9503
Fax Number	:	321-396-7711

Provider Business Practice Location Address
First Line	:	1414 KUHL AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-2008
Country	:	US
Telephone Number	:	407-805-9503
Fax Number	:	321-396-7711

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	11/15/2012

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