Provider Demographics
NPI:1730112772
Name:MAURIN, EDWARD EUGENE III (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:EUGENE
Last Name:MAURIN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6132
Mailing Address - Country:US
Mailing Address - Phone:970-298-3188
Mailing Address - Fax:970-298-3190
Practice Address - Street 1:750 WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501
Practice Address - Country:US
Practice Address - Phone:970-298-3188
Practice Address - Fax:970-298-3190
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM98-333207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODR.0053574OtherCOLORADO DORA
NM000T8659Medicaid
NMG88006Medicare UPIN