MEDICARE: ROBERT RICHARD MAES CAC III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356611677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT RICHARD MAES CAC III

Provider Business Mailing Address
First Line	:	279 S JOE MARTINEZ BLVD
Second Line	:	SUITE A
City	:	PUEBLO WEST
State	:	CO
Zip	:	81007-5439
Country	:	US
Telephone Number	:	719-647-1787
Fax Number	:	719-647-1731

Provider Business Practice Location Address
First Line	:	279 S JOE MARTINEZ BLVD
Second Line	:	SUITE A
City	:	PUEBLO WEST
State	:	CO
Zip	:	81007-5439
Country	:	US
Telephone Number	:	719-647-1787
Fax Number	:	719-647-1731

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2012
Last Update Date	:	01/03/2012

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