Provider Demographics
NPI:1063527794
Name:JAMES MAZUR DPM PA
Entity type:Organization
Organization Name:JAMES MAZUR DPM PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZUR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:704-636-7015
Mailing Address - Street 1:322 MOCKSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3328
Mailing Address - Country:US
Mailing Address - Phone:704-636-7015
Mailing Address - Fax:704-636-9788
Practice Address - Street 1:322 MOCKSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3328
Practice Address - Country:US
Practice Address - Phone:704-636-7015
Practice Address - Fax:704-636-9788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4306OtherPARTNERS
NC0803TOtherBCBS OF NC
NC890803TMedicaid
NC0396450001OtherTRICARE
NC7705153Medicaid
NC480025840OtherRAILROAD MEDICARE
NC4306OtherPARTNERS
NC480025840OtherRAILROAD MEDICARE
NC4030390001Medicare NSC
NC0396450001OtherTRICARE