Provider Demographics
NPI:1053351924
Name:MAZURE, JEFFREY M (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:MAZURE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LAUREL OAK RD STE 105
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4455
Mailing Address - Country:US
Mailing Address - Phone:856-922-9894
Mailing Address - Fax:856-922-9890
Practice Address - Street 1:15 E REDMAN AVE STE A
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2316
Practice Address - Country:US
Practice Address - Phone:856-428-1335
Practice Address - Fax:856-428-1330
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-013105207Q00000X
NJMB74824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022848140002Medicaid
PA1022848140001Medicaid
PACD4829OtherRR MEDICARE GROUP
PACD4829OtherRR MEDICARE GROUP
I13105Medicare UPIN