Provider Demographics
NPI:1780883892
Name:MAURER, ALAN RICHARD (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:RICHARD
Last Name:MAURER
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 1:836 SUNSET LAKE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-7555
Mailing Address - Country:US
Mailing Address - Phone:941-497-1771
Mailing Address - Fax:941-497-1860
Practice Address - Street 1:836 SUNSET LAKE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:24292-7555
Practice Address - Country:US
Practice Address - Phone:941-966-9277
Practice Address - Fax:941-918-8668
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME16221207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00752859OtherRAILROAD MEDICARE
FL146E9OtherBC/BS OF FLORIDA
FL146E9OtherBC/BS OF FLORIDA
FLD56940Medicare UPIN