Basic Information
| Provider Information | |||||||||
| NPI: | 1720028178 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAASS | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2016 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 644682655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6605622600 | ||||||||
| FaxNumber: | 6605627911 | ||||||||
| Practice Location | |||||||||
| Address1: | 2016 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 644682655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6605622600 | ||||||||
| FaxNumber: | 6605627911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 08/07/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 2004019691 | MO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 209201102 | 05 | MO | MEDICAID | 1720028178 | 05 | MO | MEDICAID |