Provider Demographics
NPI:1982017786
Name:MAZZAFERRO, ALEXANDER JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:JOHN
Last Name:MAZZAFERRO
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 1:4280 MID AMERICA PLACE
Mailing Address - Street 2:SUITE 30
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129
Mailing Address - Country:US
Mailing Address - Phone:314-475-2465
Mailing Address - Fax:314-782-2620
Practice Address - Street 1:4280 MID AMERICA LN STE 30
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1202
Practice Address - Country:US
Practice Address - Phone:314-782-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014017191207Q00000X
MO2017018127207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine