Provider Demographics
NPI:1427119684
Name:MAZERSKI, ALEXANDER (DO)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:MAZERSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6317 N CAMINO DE CABALUNA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6968
Mailing Address - Country:US
Mailing Address - Phone:520-219-8712
Mailing Address - Fax:
Practice Address - Street 1:6317 N CAMINO DE CABALUNA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6968
Practice Address - Country:US
Practice Address - Phone:520-219-8712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE79172Medicare UPIN
AZ101492Medicare ID - Type Unspecified