Provider Demographics
NPI:1528042660
Name:MAZO, ROBERT J (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:MAZO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD
Mailing Address - Street 2:SUITE 570
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-4969
Mailing Address - Fax:614-293-6111
Practice Address - Street 1:1707 W CHARLESTON BLVD STE 230
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2353
Practice Address - Country:US
Practice Address - Phone:702-671-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340023432084N0400X
NVDO24462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0274920Medicaid
OHC01200Medicare UPIN
OHMA0410736Medicare PIN
OH0274920Medicaid
OHMA0410735Medicare PIN
OHH346181Medicare PIN