Provider Demographics
NPI:1700873890
Name:MAURER, SUSAN J (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:MAURER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 GOVERNMENT RD
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-5108
Mailing Address - Country:US
Mailing Address - Phone:305-295-7550
Mailing Address - Fax:305-296-3010
Practice Address - Street 1:15O1 GOVERNMENT RD
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-5108
Practice Address - Country:US
Practice Address - Phone:305-295-7550
Practice Address - Fax:305-296-3010
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9101946363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291399200Medicaid
S63070Medicare UPIN
FLE7367Medicare PIN