Provider Demographics
NPI:1275785420
Name:M MAZEN JAMAL MD PC
Entity Type:Organization
Organization Name:M MAZEN JAMAL MD PC
Other - Org Name:GASTROENTEROLOGY & THERAPEUTIC ENDOSCOPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:M MAZEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-583-7888
Mailing Address - Street 1:10624 S EASTERN AVE STE A-158
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2982
Mailing Address - Country:US
Mailing Address - Phone:702-583-7888
Mailing Address - Fax:702-583-7889
Practice Address - Street 1:10624 S EASTERN AVE STE A-158
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2982
Practice Address - Country:US
Practice Address - Phone:702-583-7888
Practice Address - Fax:702-583-7889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty