Basic Information
| Provider Information | |||||||||
| NPI: | 1992098081 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAZIN | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | GENIS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34 MINOR RD | ||||||||
| Address2: | |||||||||
| City: | BREWSTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105094203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147722495 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1329 SW 16TH ST | ||||||||
| Address2: | ROOM 4270 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326081128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522655911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2011 | ||||||||
| LastUpdateDate: | 05/23/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | TRN16040 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.