Basic Information
| Provider Information | |||||||||
| NPI: | 1417265851 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAZZARELLA | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | CONFREY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8240 N MOPAC EXPY STE 100 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787598869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126871950 | ||||||||
| FaxNumber: | 5124079010 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MEDICAL PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | LAKEWAY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787385647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122630300 | ||||||||
| FaxNumber: | 5122630316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2010 | ||||||||
| LastUpdateDate: | 10/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | MD.207532 | LA | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | R5008 | TX | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.