Individual
CARL A MAZZOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 FIRST CAPITOL DRIVE, ST CHARLES, MO 63301
(636) 947-5444
(636) 947-5259
Mailing address
220 COMPASS POINT DRIVE, ST CHARLES, MO 63301
(636) 947-4480
(636) 947-9860
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2004001466
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209131705
—
MO
Enumeration date
11/10/2006
Last updated
03/18/2024
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