Provider Demographics
NPI:1215922190
Name:MAURER, ROBERT E (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
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 1:2121 AIRPARK DR
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 DR
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35391174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G353910Medicaid
CA340000085OtherRAILROAD MEDICARE
CA340000085OtherMEDICARE RR
CA340000085OtherMEDICARE RR
CA340000085OtherRAILROAD MEDICARE
CAA46337Medicare UPIN
CA00G353912Medicare PIN