Basic Information
| Provider Information | |||||||||
| NPI: | 1366406837 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAZOUE | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | GEORGE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 22265 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032967846 | ||||||||
| FaxNumber: | 8032969699 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 MEDICAL PARK RD | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292036808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034346812 | ||||||||
| FaxNumber: | 8034347306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2006 | ||||||||
| LastUpdateDate: | 03/06/2018 | ||||||||
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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 | 207X00000X | 24044 | SC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | 24044 | SC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | T81818 | 05 | SC | MEDICAID | 0534520001 | 01 | SC | MEDICARE DME | OTHER |