Provider Demographics
NPI:1043299787
Name:MAIZE, JOHN C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:MAIZE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:9295 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9137
Mailing Address - Country:US
Mailing Address - Phone:843-797-3960
Mailing Address - Fax:843-553-4216
Practice Address - Street 1:9295 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9137
Practice Address - Country:US
Practice Address - Phone:843-797-3960
Practice Address - Fax:843-553-4216
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2014-11-19
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Provider Licenses
StateLicense IDTaxonomies
SC22238207ND0900X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC222388Medicaid
SCAA12042804Medicare UPIN