Individual
DR. EARLE F MAZYCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1118 ROSS CLARK CIR, SUITE 303, DOTHAN, AL 36301-3001
(334) 794-3192
(334) 792-7513
Mailing address
1118 ROSS CLARK CIR, SUITE 303, DOTHAN, AL 36301-3001
(334) 794-3192
(334) 792-7513
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
6961
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00063192A
GEORGIA MEDICAID NUMBER
GA
01
—
051512613
AL BLUE CROSS PROVIDER
AL
05
—
051552726
—
AL
01
—
4790691001
CIGNA PROVIDER NUMBER
AL
01
—
61659
FLORIDA BLUE CROSS NUMBER
FL
01
—
P00009152
RRMC PROVIDER NUMBER
AL
Enumeration date
10/31/2005
Last updated
12/08/2009
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