Provider Demographics
NPI:1386683704
Name:ROSSBACH, MARIO MAURICIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:MAURICIO
Last Name:ROSSBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-0949
Mailing Address - Country:US
Mailing Address - Phone:830-620-1272
Mailing Address - Fax:830-620-1274
Practice Address - Street 1:1626 E COMMON
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130
Practice Address - Country:US
Practice Address - Phone:830-620-1272
Practice Address - Fax:830-620-1274
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2610208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8128N1Medicare PIN
TXH37530Medicare UPIN