Provider Demographics
NPI:1083901367
Name:MAZUR, GREGORY ALAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALAN
Last Name:MAZUR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11711 PASETTO LN APT 405
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-2670
Mailing Address - Country:US
Mailing Address - Phone:757-287-0832
Mailing Address - Fax:
Practice Address - Street 1:9915 TAMIAMI TRL N STE 1
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108
Practice Address - Country:US
Practice Address - Phone:239-566-8800
Practice Address - Fax:239-566-2671
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH057638213ES0103X
OK310213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery