Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | MD029909E | PA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD029909E | PA |
NPI | 1336121912 |
---|---|
Provider Name | Dr. Kurt Dalen Maas |
First Address | Dallas, PA 18612-9001 |
Second Address | Dallas, PA 18612-9001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0009592120007 | (05) | PA |
B34960 | (02) | PA |