Healthcare Provider Details

I. General information

NPI: 1700873890
Provider Name (Legal Business Name): SUSAN J MAURER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15O1 GOVERNMENT RD
KEY WEST FL
33040-5108
US

IV. Provider business mailing address

1501 GOVERNMENT RD
KEY WEST FL
33040-5108
US

V. Phone/Fax

Practice location:
  • Phone: 305-295-7550
  • Fax: 305-296-3010
Mailing address:
  • Phone: 305-295-7550
  • Fax: 305-296-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 9101946
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: