Healthcare Provider Details

I. General information

NPI: 1912093071
Provider Name (Legal Business Name): BRIAN THOMAS MAURER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BUCK CREEK ROAD SUITE 205
AVON CO
81620
US

IV. Provider business mailing address

PO BOX 5260
AVON CO
81620-5260
US

V. Phone/Fax

Practice location:
  • Phone: 970-949-0500
  • Fax: 970-949-0642
Mailing address:
  • Phone: 970-949-0500
  • Fax: 970-949-0642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number525
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: