Provider Demographics
NPI:1639191141
Name:MAZUREK, ROBERT T (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:MAZUREK
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 1:168 N BRENT ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2840
Mailing Address - Country:US
Mailing Address - Phone:805-641-0273
Mailing Address - Fax:805-641-0574
Practice Address - Street 1:168 N BRENT ST
Practice Address - Street 2:SUITE 501
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2840
Practice Address - Country:US
Practice Address - Phone:805-641-0273
Practice Address - Fax:805-641-0574
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46108207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46108AOtherPTAN
CA00A461080Medicaid
CAA46108AMedicare PIN
CA00A461080Medicaid