1992794986 NPI number — DANE MAXFIELD D.O.

Table of content: DANE MAXFIELD D.O. (NPI 1992794986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992794986 NPI number — DANE MAXFIELD D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAXFIELD
Provider First Name:
DANE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992794986
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13644 WALSINGHAM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33774-3532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-595-2519
Provider Business Mailing Address Fax Number:
727-631-0916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13644 WALSINGHAM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33774-3532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-595-2519
Provider Business Practice Location Address Fax Number:
727-631-0916
Provider Enumeration Date:
10/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  OS3688 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 591273247 . This is a "UHC EMPIRE PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10311 . This is a "FLORIDA WELLCARE (MEDICARE PLAN)" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 212910 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3131464 . This is a "CIGNA PPO/HMO, OPEN ACCESS, AND GREATWEST" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 388452 . This is a "UNITED HEALTHCARE COMMERCIAL AND MEDICARE PLANS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 82099 . This is a "BLUE OPTIONS, BLUE CHOICE, FEDERAL, FLORIDA STATE AND TRADITIONAL BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 710665 . This is a "MAIL HANDLERS BENEFIT PLAN (MHBP)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10311 . This is a "FLORIDA HEALTHEASE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 119461500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82099 . This is a "OUT OF STATE BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 82099 . This is a "BCBS BLUE CARE, ADVANTAGE 65 SELECT, MEDICARE PPO/HMO, GO BLUE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 100005888 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10311 . This is a "FLORIDA STAYWELL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 119461500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com