Healthcare Provider Details

I. General information

NPI: 1215961776
Provider Name (Legal Business Name): ROY L MAURER PA - C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 A ST SUITE 100
LINCOLN NE
68510-4822
US

IV. Provider business mailing address

4740 A ST SUITE 100
LINCOLN NE
68510-4822
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-7825
  • Fax: 402-483-7839
Mailing address:
  • Phone: 402-483-7825
  • Fax: 402-483-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number963
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: