Provider Demographics
NPI:1467480996
Name:MAUCK, JAMES P JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:MAUCK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:574-647-2129
Mailing Address - Fax:
Practice Address - Street 1:2405 WEST LEXINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1417
Practice Address - Country:US
Practice Address - Phone:574-524-7575
Practice Address - Fax:574-524-7576
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01035682207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000082179OtherANTHEM BLUE CROSS
IN100326890Medicaid
IN15432OtherPHYSICIANS HEALTH PLAN
IN100326890Medicaid
IN15432OtherPHYSICIANS HEALTH PLAN
IND94732Medicare UPIN