Basic Information
| Provider Information | |||||||||
| NPI: | 1518125020 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | R. GREG MAUL, D.O., P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7501 LAKEVIEW PKWY | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | ROWLETT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750889322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724633100 | ||||||||
| FaxNumber: | 8668011503 | ||||||||
| Practice Location | |||||||||
| Address1: | 7501 LAKEVIEW PKWY | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | ROWLETT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750889322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724633100 | ||||||||
| FaxNumber: | 8668011503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2008 | ||||||||
| LastUpdateDate: | 11/24/2009 | ||||||||
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| AuthorizedOfficialLastName: | MAUL | ||||||||
| AuthorizedOfficialFirstName: | ROB ERT | ||||||||
| AuthorizedOfficialMiddleName: | GREG | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9724633100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00CB16 | 01 | TX | BLUE CROSS BLUE SHIED | OTHER | DO8066 | 01 | TX | RAILROAD MEDICARE | OTHER |