Provider Demographics
NPI:1326304866
Name:MASDEU, MAURICE DOMONIQUE (PA-C)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:DOMONIQUE
Last Name:MASDEU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 SHANE CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-8607
Mailing Address - Country:US
Mailing Address - Phone:646-707-7032
Mailing Address - Fax:
Practice Address - Street 1:1536 SHANE CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8607
Practice Address - Country:US
Practice Address - Phone:646-707-7032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant