Provider Demographics
NPI:1083787063
Name:MOZEN, PAUL H (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:H
Last Name:MOZEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18653 WEDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-3323
Mailing Address - Country:US
Mailing Address - Phone:775-352-7201
Mailing Address - Fax:
Practice Address - Street 1:18653 WEDGE PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-3323
Practice Address - Country:US
Practice Address - Phone:775-352-7201
Practice Address - Fax:775-851-1583
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV367207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1083787063OtherNPI
11041276OtherCAQH
NVGL641ZMedicare PIN