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General NPI Number Information
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NPI Number | 1932858750
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Entity Type | Individual
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Provider Name | NATHAN PATRICK MAUCK MD
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Gender | Male
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Dates
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Enumeration Date | 03/20/2022
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 3150 N 12TH ST
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City | GRAND JUNCTION
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State | CO
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Zip | 81506-2863
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Country | US
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Telephone | 970-245-1220
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Fax |
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Provider Business Mailing Address
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Address Line | 6040 UNIVERSITY TOWN CENTRE DR
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City | MORGANTOWN
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State | WV
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Zip | 26501-2421
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Country | US
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Telephone | 304-598-6900
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Fax | 304-285-7373
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0075211
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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