Provider Demographics
NPI:1982759247
Name:BELZER, MAYNARD (MD)
Entity Type:Individual
Prefix:
First Name:MAYNARD
Middle Name:
Last Name:BELZER
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 1:2486 N PONDEROSA DR STE D202
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2376
Mailing Address - Country:US
Mailing Address - Phone:805-482-4641
Mailing Address - Fax:805-388-8751
Practice Address - Street 1:2486 N PONDEROSA DR STE D202
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010
Practice Address - Country:US
Practice Address - Phone:805-482-4641
Practice Address - Fax:805-388-8751
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41252207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG41252Medicare ID - Type Unspecified