Provider Demographics
NPI:1306016019
Name:ASMUSSEN, MAURICE (MD)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:ASMUSSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-3206
Mailing Address - Country:US
Mailing Address - Phone:806-765-2600
Mailing Address - Fax:806-765-2611
Practice Address - Street 1:1313 BROADWAY STE 5
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-3209
Practice Address - Country:US
Practice Address - Phone:806-765-2611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7873208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics