Provider Demographics
NPI:1659626430
Name:MAESER, NATHAN KARL (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:KARL
Last Name:MAESER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1157 N 300 W
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6124
Mailing Address - Country:US
Mailing Address - Phone:801-357-4547
Mailing Address - Fax:
Practice Address - Street 1:1157 N 300 W
Practice Address - Street 2:SUITE 303
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6124
Practice Address - Country:US
Practice Address - Phone:801-357-4547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9692048-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry