Provider Demographics
NPI:1881666535
Name:MOCZYGEMBA, MAX JOSEF (MD)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:JOSEF
Last Name:MOCZYGEMBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2866 DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-2482
Mailing Address - Country:US
Mailing Address - Phone:251-470-0552
Mailing Address - Fax:251-470-0896
Practice Address - Street 1:2866 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-2482
Practice Address - Country:US
Practice Address - Phone:251-470-0552
Practice Address - Fax:251-470-0896
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL00024164207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529900780Medicaid
ALG49646Medicare UPIN
AL051555012Medicare ID - Type Unspecified