NPIMap

Organization Active NPI

Jennifer Beth Mazer, M.D., P.a.

  • Pediatrics Physician
  • Nacogdoches, TX
National Provider Identifier
1619207883
Registry record updated Sep 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
L5043 Issued in TX
Legal business name
JENNIFER BETH MAZER, M.D., P.A.
Practice address
2714 N. University Dr.
Suite 100
Nacogdoches, TX 75965
Phone
(936) 564-4446
NPI assigned
Jan 11, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jennifer Beth Mazer
Title
President
Phone
(936) 564-4446

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X L5043 TX Primary

Addresses

Primary practice location

2714 N. University Dr.
Suite 100
Nacogdoches, TX 75965

Mailing address

2714 N. University Dr.
Suite 100
Nacogdoches, TX 75965
Phone (936) 564-4446

Other identifiers 1

IdentifierTypeStateIssuer
208543301MedicaidTX

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347926400000",
    "number": "1619207883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2714 N. UNIVERSITY DR.",
            "address_2": "SUITE 100",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "75965",
            "telephone_number": "936-564-4446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2714 N. UNIVERSITY DR.",
            "address_2": "SUITE 100",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "75965",
            "telephone_number": "936-564-4446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNIFER BETH MAZER, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-11",
        "last_updated": "2012-09-18",
        "status": "A",
        "authorized_official_last_name": "MAZER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "BETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "936-564-4446",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "L5043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208543301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nacogdoches, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.