Individual
MAZEN RAFIQUE AL-MANSOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.B.B.S
Contact information
Practice address
2 MEDICAL CENTER DRIVE, SUITE 308, SPRINGFIELD, MA 01107-1270
(413) 794-7020
(413) 794-2670
Mailing address
1600 SW ARCHER RD, BOX 100109, GAINESVILLE, FL 32610
(352) 265-0761
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
250915
MA
208600000X
Surgery Physician
Primary
ME144439
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0171953
—
OH
05
—
110093025/A
—
MA
01
—
P01701404
RAILROAD MEDICARE
OH
Enumeration date
07/16/2007
Last updated
03/05/2020
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