1952633158 NPI number — J PAUL MAHFOOD MD INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952633158 NPI number — J PAUL MAHFOOD MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J PAUL MAHFOOD MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RHEUMATOLOGY SERVICES OF FLORIDA
Provider Other Organization Name Type Code:
3
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:
1952633158
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
549 NW LAKE WHITNEY PL
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
PORT ST LUCIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34986-1606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-879-2228
Provider Business Mailing Address Fax Number:
772-879-2208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
549 NW LAKE WHITNEY PL
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
PORT ST LUCIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34986-1606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-879-2228
Provider Business Practice Location Address Fax Number:
772-879-2208
Provider Enumeration Date:
02/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MAHFOOD
Authorized Official First Name:
J
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
772-879-2228

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  ME 65617 , 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)





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