Provider Demographics
NPI:1215976105
Name:SOLIS, MAURICE M (MD)
Entity type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:M
Last Name:SOLIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2409 N PATTERSON ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2512
Mailing Address - Country:US
Mailing Address - Phone:229-259-4369
Mailing Address - Fax:229-433-6513
Practice Address - Street 1:2409 N PATTERSON ST
Practice Address - Street 2:SUITE 230
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2512
Practice Address - Country:US
Practice Address - Phone:229-259-4369
Practice Address - Fax:229-433-6513
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2014-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0306732086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA083704148OtherTRICARE
GA770002707OtherRAIL ROAD
GA00366528DMedicaid
GA52027849OtherBLUE CROSS
GAD41139Medicare UPIN
GA77BBBHXMedicare ID - Type Unspecified