Healthcare Provider Details

I. General information

NPI: 1972796597
Provider Name (Legal Business Name): MR. JOHN R MAAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 KERN WAY STE B
YAKIMA WA
98902-7805
US

IV. Provider business mailing address

3810 KERN WAY STE B
YAKIMA WA
98902-7805
US

V. Phone/Fax

Practice location:
  • Phone: 509-248-0933
  • Fax: 509-575-4763
Mailing address:
  • Phone: 509-248-0933
  • Fax: 509-575-4763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA00045688
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: