Provider Demographics
NPI:1578559092
Name:MAZA, JOHN PATRICK (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:MAZA
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2759 VALENCIA GROVE DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-5948
Mailing Address - Country:US
Mailing Address - Phone:813-684-8482
Mailing Address - Fax:
Practice Address - Street 1:7115 S BOUNDARY BLVD
Practice Address - Street 2:HEADQUARTERS, UNITED STATES CENTRAL COMMAND/CCSG
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33621-5101
Practice Address - Country:US
Practice Address - Phone:813-827-6397
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02002460A2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine