Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | MD R2G99 | MO |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD R2G99 | MO |
NPI | 1205825031 |
---|---|
Provider Name | Richard W Maack |
First Address | Chesterfield, MO 63017-3442 |
Second Address | Chesterfield, MO 63017-3662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2005 |
Last Update Date | 19/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040005176 | RAILROAD MEDICARE (01) | MO |
A28840 | (02) |