Basic Information
| Provider Information | |||||||||
| NPI: | 1386683704 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSSBACH | ||||||||
| FirstName: | MARIO | ||||||||
| MiddleName: | MAURICIO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 949 | ||||||||
| Address2: | |||||||||
| City: | LA GRANGE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 789450949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8306201272 | ||||||||
| FaxNumber: | 8306201274 | ||||||||
| Practice Location | |||||||||
| Address1: | 1626 E COMMON | ||||||||
| Address2: | |||||||||
| City: | NEW BRAUNFELS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8306201272 | ||||||||
| FaxNumber: | 8306201274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 12/30/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | L2610 | TX | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.