Provider Demographics
NPI:1689744518
Name:MAUS, MARK (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:MAUS
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Gender:M
Credentials:DO
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Mailing Address - Street 1:2101 COURAGE DR
Mailing Address - Street 2:MS 10-100
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6717
Mailing Address - Country:US
Mailing Address - Phone:707-784-2048
Mailing Address - Fax:707-784-2032
Practice Address - Street 1:2101 COURAGE DR
Practice Address - Street 2:MS 10-100
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6717
Practice Address - Country:US
Practice Address - Phone:707-784-2048
Practice Address - Fax:707-784-2032
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-04-15
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Provider Licenses
StateLicense IDTaxonomies
CA20A5128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX51280Medicaid
C03005Medicare UPIN