MEDICARE: DONALD M MAULDIN, MD, ASSOC

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	174400000X	Specialist	E2708	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	200043244	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0096QV	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1649321571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD M MAULDIN, MD, ASSOC

Provider Business Mailing Address
First Line	:	PO BOX 617
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-0617
Country	:	US
Telephone Number	:	972-991-9950
Fax Number	:	972-991-4026

Provider Business Practice Location Address
First Line	:	5920 FOREST PARK RD
Second Line	:	STE 600
City	:	DALLAS
State	:	TX
Zip	:	75235-6411
Country	:	US
Telephone Number	:	214-902-1440
Fax Number	:	214-902-1593

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	DONALD M MAULDIN
Credential	:	MD
Telephone Number	:	972-991-9950

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/13/2009

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