Provider Demographics
NPI:1881877207
Name:ROBERT E MAURER MD INC
Entity type:Organization
Organization Name:ROBERT E MAURER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-244-6001
Mailing Address - Street 1:2121 AIRPARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2433
Mailing Address - Country:US
Mailing Address - Phone:530-244-6001
Mailing Address - Fax:530-244-6005
Practice Address - Street 1:2121 AIRPARK DRIVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2433
Practice Address - Country:US
Practice Address - Phone:530-244-6001
Practice Address - Fax:530-244-6005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35391174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA340000085OtherRR MEDICARE
CA00G353910Medicaid
CAA46337Medicare UPIN
CAZZZ29168ZMedicare PIN
CA0713570001Medicare NSC