Provider Demographics
NPI:1598982910
Name:MAZER, JEFFREY M (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:MAZER
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 1:500 WALTER ST NE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2534
Mailing Address - Country:US
Mailing Address - Phone:505-727-3170
Mailing Address - Fax:505-727-3171
Practice Address - Street 1:500 WALTER ST NE
Practice Address - Street 2:SUITE 501
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2534
Practice Address - Country:US
Practice Address - Phone:505-727-3170
Practice Address - Fax:505-727-3171
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12999207RP1001X, 207RC0200X, 207R00000X
NMMD2014-0236207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM68228546Medicaid
NM82555753YPPRMedicare PIN