Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036.119290 | IL |
N | 208600000X | Surgeon | 036.119290 | IL |
N | 208200000X | Surgeon | 39356 | IA |
N | 208600000X | Surgeon | 39356 | IA |
N | 2086S0122X | Plastic and Reconstructive Surgery | 036.119290 | IL |
N | 2086S0122X | Plastic and Reconstructive Surgery | 39356 | IA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD-39356 | IA |
NPI | 1033328109 |
---|---|
Provider Name | Samuel M Maurice |
First Address | Des Moines, IA 50305-1475 |
Second Address | Des Moines, IA 50314-3017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2014 |