MEDICARE: MR. DALE MAURO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	JB6798	FL

General Provider Information

NPI Number	:	1942625355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DALE MAURO

Provider Business Mailing Address
First Line	:	3793 OLEANDER AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-6503
Country	:	US
Telephone Number	:	772-871-7038
Fax Number	:

Provider Business Practice Location Address
First Line	:	3793 OLEANDER AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-6503
Country	:	US
Telephone Number	:	772-871-7038
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2014
Last Update Date	:	02/21/2014

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Directions to “ MR. DALE MAURO ” Practice Location

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