Provider Demographics
NPI:1003249905
Name:PAULUS, MAUREEN MCMAHON (PA)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:MCMAHON
Last Name:PAULUS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:PATRICIA
Other - Last Name:MCMAHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 742785
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2785
Mailing Address - Country:US
Mailing Address - Phone:541-342-2134
Mailing Address - Fax:541-684-3074
Practice Address - Street 1:920 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 200A
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6024
Practice Address - Country:US
Practice Address - Phone:541-342-2134
Practice Address - Fax:541-686-6021
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA164242363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500664027Medicaid
ORPA164242OtherOREGON LICENSE
ORR172043Medicare PIN