Individual
TERESA M MAZUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
400 HEALTH PARK BLVD, ST AUGUSTINE, FL 32086-5784
(904) 826-4700
(904) 346-0113
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME0066495
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26101
BCBS
FL
05
—
376205000
—
FL
01
—
P00331048
RAILROAD MEDICARE - FLAGL
FL
Enumeration date
10/04/2006
Last updated
10/17/2019
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