Individual
ROBERTO S MAURICIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
102 OLD JEFFERSON ST, CELINA, TN 38551
(931) 243-3576
(931) 243-2751
Mailing address
102 OLD JEFFERSON ST, CELINA, TN 38551
(931) 243-3576
(931) 243-2751
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD0000007826
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13790
BCBS
TN
05
—
3152445
—
TN
Enumeration date
10/06/2006
Last updated
07/08/2007
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