MEDICARE: DR. RANDOLPH O MAUL MD

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	207P00000X	Emergency Medicine Physician	31283	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	930027387	OTHER	CO	RR MEDICARE

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	:	1649229873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDOLPH O MAUL MD

Provider Business Mailing Address
First Line	:	19681 ROYAL TROON DR
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-2874
Country	:	US
Telephone Number	:	719-659-1170
Fax Number	:	719-559-0464

Provider Business Practice Location Address
First Line	:	19681 ROYAL TROON DR
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-2874
Country	:	US
Telephone Number	:	719-659-1170
Fax Number	:	719-559-0464

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

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	04/30/2018

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