Healthcare Provider Details

I. General information

NPI: 1184825994
Provider Name (Legal Business Name): SAMUEL SCOTT MARONEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 ANTILLEY RD
ABILENE TX
79606-5209
US

IV. Provider business mailing address

257 RUGER ST
TUSCOLA TX
79562-3917
US

V. Phone/Fax

Practice location:
  • Phone: 325-698-3865
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberN5838
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: