Provider Demographics
NPI:1225049752
Name:MAZUR, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:MAZUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3901 UNIVERSITY BLVD S STE 103
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4374
Mailing Address - Country:US
Mailing Address - Phone:049-345-7373
Mailing Address - Fax:904-345-7372
Practice Address - Street 1:3901 UNIVERSITY BLVD S STE 103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4374
Practice Address - Country:US
Practice Address - Phone:904-345-7373
Practice Address - Fax:904-345-7372
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-08-12
Deactivation Date:2019-10-07
Deactivation Code:
Reactivation Date:2019-10-29
Provider Licenses
StateLicense IDTaxonomies
FLME55536207X00000X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000446619AMedicaid
FL61888800Medicaid
FL61888800Medicaid
GA000446619AMedicaid