Provider Demographics
NPI:1861783938
Name:ISKANDAR, MAZEN (MD)
Entity type:Individual
Prefix:DR
First Name:MAZEN
Middle Name:
Last Name:ISKANDAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 N I 35 STE 215
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5271
Mailing Address - Country:US
Mailing Address - Phone:469-800-9830
Mailing Address - Fax:
Practice Address - Street 1:2460 N I 35 STE 215
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5271
Practice Address - Country:US
Practice Address - Phone:469-800-9830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277205208600000X
390200000X
TXR9083208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program