Provider Demographics
NPI:1144591249
Name:MAYNOLDI, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MAYNOLDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5000-18 US HIGHWAY 17 SOUTH
Mailing Address - Street 2:241
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003
Mailing Address - Country:US
Mailing Address - Phone:877-842-4020
Mailing Address - Fax:877-842-4020
Practice Address - Street 1:1202 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4632
Practice Address - Country:US
Practice Address - Phone:877-842-4020
Practice Address - Fax:877-842-4020
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130811207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME130811OtherFLORIDA MEDICAL LICENSE
FL163944OtherABFM
GA73904OtherMEDICAL LICENSE