Provider Demographics
NPI:1720056153
Name:MAROON, T J II (MD)
Entity Type:Individual
Prefix:DR
First Name:T
Middle Name:J
Last Name:MAROON
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5098 FOOTHILLS BLVD # 3-335
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-6526
Mailing Address - Country:US
Mailing Address - Phone:916-765-8698
Mailing Address - Fax:916-783-6695
Practice Address - Street 1:729 SUNRISE AVE STE 602
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4542
Practice Address - Country:US
Practice Address - Phone:916-953-7571
Practice Address - Fax:916-771-8515
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55307207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0046250Medicaid
CAGR0046250Medicaid
CAG19857Medicare UPIN