Provider Demographics
NPI:1891769709
Name:MAZZARE, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:MAZZARE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5380 OLD BULLARD RD STE 600-357
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3607
Mailing Address - Country:US
Mailing Address - Phone:888-316-5498
Mailing Address - Fax:888-979-6378
Practice Address - Street 1:5380 OLD BULLARD RD STE 600-357
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3607
Practice Address - Country:US
Practice Address - Phone:888-316-5498
Practice Address - Fax:888-979-6378
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK3331207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127039910Medicaid
G48147Medicare UPIN
TX127039910Medicaid