Basic Information
| Provider Information | |||||||||
| NPI: | 1487673695 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAZZOLA | ||||||||
| FirstName: | HARRY | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3046 | ||||||||
| Address2: | |||||||||
| City: | MALVERN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193550746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8064525522 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 301 N 23RD ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | CANYON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790153028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8064525522 | ||||||||
| FaxNumber: | 8064523070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 08/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | G0966 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207Q00000X | G0966 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 160046831 | 01 | TX | RRM | OTHER | 8GE512 | 01 | TX | BCBS OF TX | OTHER | 00FR71 | 01 | TX | BCBS | OTHER | 1231052-05 | 05 | TX | MEDICAID | 1487673695 | 01 | TX | NPI | OTHER |