MEDICARE: DR. MARTIN L MAYSE 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	207RP1001X	Pulmonary Disease Physician	2003018930	MO

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	:	1790701910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN L MAYSE MD

Provider Business Mailing Address
First Line	:	660 S EUCLID AVE
Second Line	:	C B 8052
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1010
Country	:	US
Telephone Number	:	314-454-8917
Fax Number	:	314-454-5571

Provider Business Practice Location Address
First Line	:	4960 CHILDRENS PL
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1000
Country	:	US
Telephone Number	:	314-454-8917
Fax Number	:	314-454-5571

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	01/27/2009

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