Provider Demographics
NPI:1205819208
Name:MAYNARD, DUANE WARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:WARD
Last Name:MAYNARD
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:PO BOX 240098
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-0098
Mailing Address - Country:US
Mailing Address - Phone:210-621-0640
Mailing Address - Fax:210-621-2386
Practice Address - Street 1:11026 ANAQUA SPGS
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-8491
Practice Address - Country:US
Practice Address - Phone:210-621-0640
Practice Address - Fax:210-621-2386
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6417207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130527810Medicaid
TX8CA823OtherBLUE CROSS
TX130527810Medicaid