Healthcare Provider Details

I. General information

NPI: 1417939067
Provider Name (Legal Business Name): RICHARD C MAUER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W 23RD ST
PANAMA CITY FL
32405-2349
US

IV. Provider business mailing address

2800 ROSS CLARK CIR
DOTHAN AL
36301-2040
US

V. Phone/Fax

Practice location:
  • Phone: 850-784-3936
  • Fax: 850-784-3539
Mailing address:
  • Phone: 334-793-2211
  • Fax: 334-793-7161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME141272
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number52732
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number24873
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: