Active NPI
Earle F Mazyck, M.D.
- Internal Medicine Physician
- Dothan, AL
National Provider Identifier
1720079726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 6961
- Practice address
- 1118 Ross Clark Cir
Suite 303
Dothan, AL 36301-3001 - Phone
- (334) 794-3192
- Fax
- (334) 792-7513
- NPI assigned
- Oct 31, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 6961 | AL | Primary |
Addresses
Primary practice location
1118 Ross Clark Cir
Suite 303
Dothan, AL 36301-3001
Mailing address
1118 Ross Clark Cir
Suite 303
Dothan, AL 36301-3001
Phone (334) 794-3192
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 051552726 | Medicaid | AL | |
| 051512613 | Other | AL | AL BLUE CROSS PROVIDER |
| P00009152 | Other | AL | RRMC PROVIDER NUMBER |
| 61659 | Other | FL | FLORIDA BLUE CROSS NUMBER |
| 4790691001 | Other | AL | CIGNA PROVIDER NUMBER |
| 00063192A | Other | GA | GEORGIA MEDICAID NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260230400000",
"number": "1720079726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1118 ROSS CLARK CIR",
"address_2": "SUITE 303",
"city": "DOTHAN",
"state": "AL",
"postal_code": "363013001",
"telephone_number": "334-794-3192",
"fax_number": "334-792-7513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1118 ROSS CLARK CIR",
"address_2": "SUITE 303",
"city": "DOTHAN",
"state": "AL",
"postal_code": "363013001",
"telephone_number": "334-794-3192",
"fax_number": "334-792-7513"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZYCK",
"first_name": "EARLE",
"middle_name": "F",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-31",
"last_updated": "2009-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "AL",
"license": "6961",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "051552726",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AL BLUE CROSS PROVIDER",
"identifier": "051512613",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RRMC PROVIDER NUMBER",
"identifier": "P00009152",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FLORIDA BLUE CROSS NUMBER",
"identifier": "61659",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA PROVIDER NUMBER",
"identifier": "4790691001",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEORGIA MEDICAID NUMBER",
"identifier": "00063192A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dothan, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.