Provider Demographics
NPI:1306854963
Name:MAUTERER, DAVID JOHN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:MAUTERER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 636961
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6961
Mailing Address - Country:US
Mailing Address - Phone:513-981-5130
Mailing Address - Fax:513-981-5015
Practice Address - Street 1:225 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 303
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7915
Practice Address - Country:US
Practice Address - Phone:270-442-9463
Practice Address - Fax:270-442-2241
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC39195208600000X
KY46723208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64521461Medicaid
NC8955038Medicaid
NC8955038Medicaid
NCE48207Medicare UPIN
NCE48207Medicare UPIN