MEDICARE: MAURICIO MASFERRER 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	2084P0800X	Psychiatry Physician	0418009	KS
2	2084P0800X	Psychiatry Physician	60217	GA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972595429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURICIO MASFERRER M.D.

Provider Business Mailing Address
First Line	:	300 EAST HOSPITAL ROAD, BUILDING 300, 13 FLOOR. OBHS
Second Line	:	DWIGHT D EISENHOWER ARMY MEDICAL CENTER
City	:	FORT GORDON
State	:	GA
Zip	:	30905-5650
Country	:	US
Telephone Number	:	706-787-2039
Fax Number	:	706-787-5625

Provider Business Practice Location Address
First Line	:	300 EAST HOSPITAL ROAD, 13 FLOOR. OBHS
Second Line	:	DWIGHT D EISENHOWER ARMY MEDICAL CENTER
City	:	FORT GORDON
State	:	GA
Zip	:	30905-5650
Country	:	US
Telephone Number	:	706-787-2039
Fax Number	:	706-787-5625

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	12/10/2013

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