1639173669 NPI number — DR. MARK LAWRENCE MAZOW M.D.

Table of content: ARNOLD MING (NPI 1770171126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639173669 NPI number — DR. MARK LAWRENCE MAZOW M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAZOW
Provider First Name:
MARK
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639173669
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3705 MEDICAL PKWY STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78705-1022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-458-2141
Provider Business Mailing Address Fax Number:
512-458-4824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3705 MEDICAL PKWY STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78705-1022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-458-2141
Provider Business Practice Location Address Fax Number:
512-458-4824
Provider Enumeration Date:
06/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  H2575 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0200X , with the licence number: H2575 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20801 . This is a "TOTAL VISION HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 100401610B . This is a "KANSAS MEDICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 388561 . This is a "WELLCARE PPO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4232994 . This is a "AETNA PPO, POS, & EPO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5692 . This is a "PARKLAND KIDS FIRST" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 100752320A . This is a "OKLAHOMA MEDICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 29761 . This is a "AMERIGROUP/AMERICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3566323 . This is a "HEALTH MARKET" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 388561 . This is a "WELLCARE HMO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 131458501 . This is a "CID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 180009584 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 128003001 . This is a "AR MEDICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8658B7 . This is a "MEDICARE DEFAULT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0612278 . This is a "AETNA HMO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2819152007 . This is a "TOTAL VISION HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 358046 . This is a "ONE HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 081148 . This is a "PCA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8658B7 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: H2575 . This is a "UNICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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