Individual
DR. MARK LAWRENCE MAZOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7777 FOREST LANE, SUITE C-710, DALLAS, TX 75230-2571
(972) 566-2020
(972) 566-5454
Mailing address
7777 FOREST LANE, SUITE C-710, DALLAS, TX 75230-2571
(972) 566-2020
(972) 566-5454
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
H2575
TX
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
H2575
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0612278
AETNA HMO
TX
01
—
081148
PCA
TX
01
—
100401610B
KANSAS MEDICAID
TX
01
—
100752320A
OKLAHOMA MEDICAID
TX
01
—
128003001
AR MEDICAID
TX
01
—
131458501
CID
TX
01
—
180009584
RAILROAD MEDICARE
TX
01
—
20801
TOTAL VISION HEALTHCARE
TX
01
—
2819152007
TOTAL VISION HEALTHCARE
TX
01
—
29761
AMERIGROUP/AMERICAID
TX
01
—
3566323
HEALTH MARKET
TX
01
—
358046
ONE HEALTH
TX
01
—
388561
WELLCARE PPO
TX
01
—
4232994
AETNA PPO, POS, & EPO
TX
01
—
5692
PARKLAND KIDS FIRST
TX
01
—
8658B7
MEDICARE DEFAULT
TX
01
—
H2575
UNICARE
TX
Enumeration date
06/08/2005
Last updated
11/02/2022
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