MEDICARE: JOEL RUSSEL MAUST 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	207Q00000X	Family Medicine Physician	J6570	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00U61E	OTHER	TX	MEDICARE GROUP NUMBER

Other Identifiers

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

General Provider Information

NPI Number	:	1801833314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL RUSSEL MAUST M.D.

Provider Business Mailing Address
First Line	:	3310 OAKWELL CT APT 16304
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-3980
Country	:	US
Telephone Number	:	214-282-6594
Fax Number	:

Provider Business Practice Location Address
First Line	:	3310 OAKWELL CT APT 16304
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-3980
Country	:	US
Telephone Number	:	214-282-6594
Fax Number	:

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	04/21/2022

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