Provider Demographics
NPI:1891731659
Name:MAURIC, JOHN M (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:MAURIC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 3RD AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-3269
Mailing Address - Country:US
Mailing Address - Phone:419-355-8070
Mailing Address - Fax:419-355-1109
Practice Address - Street 1:605 3RD AVE
Practice Address - Street 2:SUITE D
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-3269
Practice Address - Country:US
Practice Address - Phone:419-355-8070
Practice Address - Fax:419-355-1109
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-004778207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH080172711OtherRAILROAD MEDICARE
OH0827627Medicaid
OH000000201363OtherANTHEM B/C B/S
OH740142OtherBUCKEYE MEDICAID
OHR04778OtherSUMMACARE
OH0827627Medicaid
OHH282490Medicare PIN
OHR04778OtherSUMMACARE