Individual
MAURICE DUSOL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1041 N CHINA LAKE BLVD, B, RIDGECREST, CA 93555-3183
(760) 446-6404
(760) 446-6415
Mailing address
1081 N CHINA LAKE BLVD, RIDGECREST, CA 93555-3130
(760) 446-0121
(760) 446-0734
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
G20524
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G205240
—
CA
01
—
A109
CHAMPUS
—
Enumeration date
09/26/2005
Last updated
05/17/2021
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