Provider Demographics
NPI:1417248063
Name:MAZOCH, CAROLINE DUOS (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:DUOS
Last Name:MAZOCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 DAVE WARD DR STE 601
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8685
Mailing Address - Country:US
Mailing Address - Phone:501-328-0055
Mailing Address - Fax:
Practice Address - Street 1:2425 DAVE WARD DR STE 601
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8685
Practice Address - Country:US
Practice Address - Phone:501-328-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-8647208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics