Individual
ANDREW MAZZONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
775 POLE LINE RD W STE 301, TWIN FALLS, ID 83301-5823
(208) 814-8700
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
10959125-1205
UT
208800000X
Urology Physician
114025
MT
208800000X
Urology Physician
25185
NV
208800000X
Urology Physician
Primary
M-16761
ID
Other
Enumeration date
04/20/2017
Last updated
07/15/2024
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