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1831170968

NPI Code Detail

MEDICARE: GARY MAASSEN M.D.

MEDICARE: GARY MAASSEN 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	207R00000X	Internal Medicine Physician	R7H60	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	127466	OTHER	MO	GHP
2	26093	OTHER	MO	BCBS
3	260293	OTHER	MO	HEALTHLINK
4	0400519	OTHER	MO	UHC
5	4540903	OTHER	MO	AETNA
6	000000010024	OTHER	MO	ESSENCE
7	127490	OTHER	MO	GHP
8	F92833	OTHER	MO	MERCY
9	25688	OTHER	MO	BCBS

General Provider Information

NPI Number	:	1831170968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY MAASSEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 23340
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63156-3340
Country	:	US
Telephone Number	:	314-843-7333
Fax Number	:	314-843-9946

Provider Business Practice Location Address
First Line	:	5034 GRIFFIN RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-3418
Country	:	US
Telephone Number	:	314-843-7333
Fax Number	:	314-843-9946

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	09/24/2012

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1174504146 — JAMES EBEL M.D.
Practice Location Address:

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1245204338 — MARC O. MERBAUM M.D.
Practice Location Address:

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Directions to “ GARY MAASSEN M.D.” Practice Location

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