Provider Demographics
NPI:1972595429
Name:MASFERRER, MAURICIO (MD)
Entity Type:Individual
Prefix:
First Name:MAURICIO
Middle Name:
Last Name:MASFERRER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 EAST HOSPITAL ROAD, BUILDING 300, 13 FLOOR. OBHS
Mailing Address - Street 2:DWIGHT D EISENHOWER ARMY MEDICAL CENTER
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:706-787-2039
Mailing Address - Fax:706-787-5625
Practice Address - Street 1:300 EAST HOSPITAL ROAD, 13 FLOOR. OBHS
Practice Address - Street 2:DWIGHT D EISENHOWER ARMY MEDICAL CENTER
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-2039
Practice Address - Fax:706-787-5625
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04180092084P0800X
GA602172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ987753Medicaid
NM86935828Medicaid
NM86935828Medicaid
KS104833Medicare ID - Type Unspecified
AZ987753Medicaid