Individual
MAZEN SIRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 357-8310
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 501-2188
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
60496111205
UT
208M00000X
Hospitalist Physician
Primary
6049611-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000059004
MEDICARE
UT
01
—
P00317619
PALMETTO
UT
Enumeration date
05/09/2006
Last updated
04/19/2023
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