Provider Demographics
NPI:1831184597
Name:MAZOW, MALCOLM L (MD)
Entity type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:L
Last Name:MAZOW
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7155 OLD KATY RD
Mailing Address - Street 2:N100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2134
Mailing Address - Country:US
Mailing Address - Phone:713-668-6828
Mailing Address - Fax:832-280-3636
Practice Address - Street 1:2855 GRAMERCY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025
Practice Address - Country:US
Practice Address - Phone:713-668-6828
Practice Address - Fax:713-668-3823
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2020-04-19
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Provider Licenses
StateLicense IDTaxonomies
TXC9067207WX0110X, 207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC19004Medicare UPIN