Healthcare Provider Details

I. General information

NPI: 1003249905
Provider Name (Legal Business Name): MAUREEN MCMAHON PAULUS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAUREEN PATRICIA MCMAHON PA

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 COUNTRY CLUB RD SUITE 200A
EUGENE OR
97401-6024
US

IV. Provider business mailing address

PO BOX 742785
LOS ANGELES CA
90074-2785
US

V. Phone/Fax

Practice location:
  • Phone: 541-342-2134
  • Fax: 541-686-6021
Mailing address:
  • Phone: 541-342-2134
  • Fax: 541-684-3074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA164242
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500664027
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
IdentifierPA164242
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerOREGON LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: