Provider Demographics
NPI:1619207883
Name:JENNIFER BETH MAZER, M.D., P.A.
Entity Type:Organization
Organization Name:JENNIFER BETH MAZER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:MAZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-564-4446
Mailing Address - Street 1:2714 N. UNIVERSITY DR.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965
Mailing Address - Country:US
Mailing Address - Phone:936-564-4446
Mailing Address - Fax:
Practice Address - Street 1:2714 N. UNIVERSITY DR.
Practice Address - Street 2:SUITE 100
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965
Practice Address - Country:US
Practice Address - Phone:936-564-4446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5043208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208543301Medicaid
TXH72163Medicare UPIN