Provider Demographics
NPI:1285624296
Name:MEZOFF, JOHN M (MD)
Entity type:Individual
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First Name:JOHN
Middle Name:M
Last Name:MEZOFF
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8801 HORIZON BLVD NE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1533
Mailing Address - Country:US
Mailing Address - Phone:505-828-4923
Mailing Address - Fax:505-213-0103
Practice Address - Street 1:231 NIZHONI BLVD
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5792
Practice Address - Country:US
Practice Address - Phone:505-722-2268
Practice Address - Fax:505-863-2874
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2008-04-25
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Provider Licenses
StateLicense IDTaxonomies
NM80-67207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM001869OtherBC BS OF NM
NM13649Medicaid
NM180014478OtherRRB MEDICARE RAILROAD
AZ239930Medicaid
NMC97976Medicare UPIN
NM13649Medicaid