MEDICARE: DR. BRYAN J MAZEY III D.O.

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	207W00000X	Ophthalmology Physician	5101011409	MI

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

General Provider Information

NPI Number	:	1730165846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN J MAZEY III D.O.

Provider Business Mailing Address
First Line	:	36821 GREEN ST
Second Line	:
City	:	NEW BALTIMORE
State	:	MI
Zip	:	48047-1607
Country	:	US
Telephone Number	:	586-716-4959
Fax Number	:	586-716-2936

Provider Business Practice Location Address
First Line	:	36821 GREEN ST
Second Line	:
City	:	NEW BALTIMORE
State	:	MI
Zip	:	48047-1607
Country	:	US
Telephone Number	:	586-716-4959
Fax Number	:	586-716-2936

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	05/19/2014

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