Provider Demographics
NPI:1114059821
Name:MAZE, JAMES G (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:MAZE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:G
Other - Last Name:MAZE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD APMC
Mailing Address - Street 1:PO BOX 3066
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602
Mailing Address - Country:US
Mailing Address - Phone:337-494-2125
Mailing Address - Fax:337-494-2360
Practice Address - Street 1:1701 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601
Practice Address - Country:US
Practice Address - Phone:337-494-2121
Practice Address - Fax:337-494-2360
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11247R2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1661635Medicaid
E93699Medicare UPIN
LA1661635Medicaid