Provider Demographics
NPI:1639173669
Name:MAZOW, MARK LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:LAWRENCE
Last Name:MAZOW
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7777 FOREST LANE
Mailing Address - Street 2:SUITE C-710
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2571
Mailing Address - Country:US
Mailing Address - Phone:972-566-2020
Mailing Address - Fax:972-566-5454
Practice Address - Street 1:7777 FOREST LANE
Practice Address - Street 2:SUITE C-710
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2571
Practice Address - Country:US
Practice Address - Phone:972-566-2020
Practice Address - Fax:972-566-5454
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH2575207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100401610BOtherKANSAS MEDICAID
TX131458501OtherCID
TX388561OtherWELLCARE PPO
TX4232994OtherAETNA PPO, POS, & EPO
TX081148OtherPCA
TX20801OtherTOTAL VISION HEALTHCARE
TX29761OtherAMERIGROUP/AMERICAID
TX2819152007OtherTOTAL VISION HEALTHCARE
TX5692OtherPARKLAND KIDS FIRST
TX3566323OtherHEALTH MARKET
TX8658B7OtherMEDICARE DEFAULT
TXH2575OtherUNICARE
TX0612278OtherAETNA HMO
TX8658B7OtherBCBS
TX180009584OtherRAILROAD MEDICARE
TX100752320AOtherOKLAHOMA MEDICAID
TX128003001OtherAR MEDICAID
TX358046OtherONE HEALTH
TX388561OtherWELLCARE HMO
TX100401610BOtherKANSAS MEDICAID