Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 10707 | NV |
N | 207PE0004X | Emergency Medical Services | 10707 | NV |
NPI | 1194802405 |
---|---|
Provider Name | Maurice A. Mayer |
First Address | Carson City, NV 89703-4625 |
Second Address | Carson City, NV 89703-4625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 15/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100510683 | (05) | NV |
B004 | TRICARE (01) | NV |
G73505 | (02) | NV |
NV4619 | BCBS (01) | NV |