Provider Demographics
NPI:1215961776
Name:MAURER, ROY L (PA - C)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:L
Last Name:MAURER
Suffix:
Gender:M
Credentials:PA - C
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4740 A ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4822
Mailing Address - Country:US
Mailing Address - Phone:402-483-7825
Mailing Address - Fax:402-483-7839
Practice Address - Street 1:4740 A ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4822
Practice Address - Country:US
Practice Address - Phone:402-483-7825
Practice Address - Fax:402-483-7839
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-11-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE963363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47059807113Medicaid
NE47059807113Medicaid
NEP27211Medicare UPIN