Provider Demographics
NPI:1891228649
Name:HART, MAURENE (DO)
Entity Type:Individual
Prefix:DR
First Name:MAURENE
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1315 SANTA FE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2241
Mailing Address - Country:US
Mailing Address - Phone:361-203-4969
Mailing Address - Fax:361-200-2092
Practice Address - Street 1:1315 SANTA FE ST STE 101
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2241
Practice Address - Country:US
Practice Address - Phone:361-203-4969
Practice Address - Fax:361-200-2092
Is Sole Proprietor?:No
Enumeration Date:2017-04-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS5647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine