Provider Demographics
NPI:1629142898
Name:MAZZOLA, ROBERT L (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:MAZZOLA
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 1:8TH & C STREET
Mailing Address - Street 2:INTERMOUNTAIN SLEEP DISORDERS CENTER - LDS HOSPITAL
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84143
Mailing Address - Country:US
Mailing Address - Phone:801-408-3617
Mailing Address - Fax:801-412-3160
Practice Address - Street 1:8TH & C STREET
Practice Address - Street 2:INTERMOUNTAIN SLEEP DISORDERS CENTER - LDS HOSPITAL
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143
Practice Address - Country:US
Practice Address - Phone:801-408-3617
Practice Address - Fax:801-412-3160
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5860780-1205207RC0200X, 207RP1001X, 207R00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine