Provider Demographics
NPI:1982847596
Name:R. GREG MAUL, D.O., P.A.
Entity Type:Organization
Organization Name:R. GREG MAUL, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GREG
Authorized Official - Last Name:MAUL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-463-3100
Mailing Address - Street 1:7501 LAKEVIEW PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-9322
Mailing Address - Country:US
Mailing Address - Phone:972-463-3100
Mailing Address - Fax:866-801-1503
Practice Address - Street 1:440 STATE HIGHWAY 78
Practice Address - Street 2:SUITE 220
Practice Address - City:LAVON
Practice Address - State:TX
Practice Address - Zip Code:75166-1265
Practice Address - Country:US
Practice Address - Phone:972-463-3100
Practice Address - Fax:866-801-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXRAILROAD MEDICAREOtherDO8066