Provider Demographics
NPI:1902079312
Name:MAZICK, GREGORY WILLIAM (RN)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:WILLIAM
Last Name:MAZICK
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:GREGORY
Other - Middle Name:WILLIAM
Other - Last Name:MAZICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:11343 BALD MTN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-2663
Mailing Address - Country:US
Mailing Address - Phone:210-286-9234
Mailing Address - Fax:
Practice Address - Street 1:6655 FIRST PARK TEN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-4304
Practice Address - Country:US
Practice Address - Phone:210-737-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX667377163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse