Provider Demographics
NPI:1467538397
Name:MARIS, DREW E
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:E
Last Name:MARIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 ANDERSEN DR STE 1108
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3999
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 ANDERSEN DR STE 1108
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3999
Practice Address - Country:US
Practice Address - Phone:415-455-0914
Practice Address - Fax:831-438-2473
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ72284ZMedicare ID - Type Unspecified
H86382Medicare UPIN