Individual
BRUCE A MAZUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT DC
Contact information
Practice address
1401 MACLOVIA, SUITE G, SANTA FE, NM 87505
(505) 471-0818
(505) 471-0822
Mailing address
822 RIO VISTA, SANTA FE, NM 87501
(505) 470-6729
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2379
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2379
STATE OF NM REG. AND LIC.
NM
01
—
NM000651
BLUE CROSS BLUE SHIELD
NM
Enumeration date
08/04/2005
Last updated
07/08/2007
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