Provider Demographics
NPI:1487673695
Name:CAZZOLA, HARRY J (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:J
Last Name:CAZZOLA
Suffix:
Gender:M
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:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:806-452-5522
Mailing Address - Fax:
Practice Address - Street 1:301 N 23RD ST
Practice Address - Street 2:SUITE C
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-3028
Practice Address - Country:US
Practice Address - Phone:806-452-5522
Practice Address - Fax:806-452-3070
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0966207VG0400X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160046831OtherRRM
TX8GE512OtherBCBS OF TX
TX00FR71OtherBCBS
TX1231052-05Medicaid
TX1487673695OtherNPI
TX00FR71Medicare PIN
TX00FR71OtherBCBS
A41812Medicare UPIN