Provider Demographics
NPI:1083637649
Name:MAYO, EDWARD PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:PAUL
Last Name:MAYO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4131 NW 13TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-4151
Mailing Address - Country:US
Mailing Address - Phone:352-376-1887
Mailing Address - Fax:352-375-7451
Practice Address - Street 1:6500 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4309
Practice Address - Country:US
Practice Address - Phone:352-333-4180
Practice Address - Fax:352-333-4861
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8378207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
050089955OtherRR MEDICARE
13060OtherBCBS
FL264346400Medicaid
13060OtherBCBS
FL264346400Medicaid