Provider Demographics
NPI:1457313108
Name:MAURER, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:MAURER
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:PO BOX 2065
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98111-2065
Mailing Address - Country:US
Mailing Address - Phone:888-633-0083
Mailing Address - Fax:
Practice Address - Street 1:1046 W 6TH AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321
Practice Address - Country:US
Practice Address - Phone:503-926-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24564207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA187366OtherWASHINGTON L & I
OR227442Medicaid
OR059297000OtherBLUE CROSS/BLUE SHIELD
134057OtherWASHINGTON L&I
P00138951OtherRAILROAD MEDICARE
WA8938590OtherWASHINGTON CRIME VICTIMS
059297000OtherBC/BS OF OREGON
WA8398547Medicaid
H46654OtherPROVIDENCE HEALTH PLANS
H46654Medicare UPIN
WA8398547Medicaid