MEDICARE: DR. T J MAROON II M.D.

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	207L00000X	Anesthesiology Physician	A55307	CA
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	A55307	CA

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	:	1720056153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. T J MAROON II M.D.

Provider Business Mailing Address
First Line	:	5098 FOOTHILLS BLVD # 3-335
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95747-6526
Country	:	US
Telephone Number	:	916-765-8698
Fax Number	:	916-783-6695

Provider Business Practice Location Address
First Line	:	729 SUNRISE AVE STE 602
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-4542
Country	:	US
Telephone Number	:	916-953-7571
Fax Number	:	916-771-8515

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	04/09/2020

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