Provider Demographics
NPI:1275534315
Name:MAAS, PAUL DAVID (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:MAAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 PARK ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-1042
Mailing Address - Country:US
Mailing Address - Phone:727-545-4545
Mailing Address - Fax:727-548-1360
Practice Address - Street 1:5301 PARK ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-1042
Practice Address - Country:US
Practice Address - Phone:727-545-4545
Practice Address - Fax:727-548-1360
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL053480207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E32094Medicare UPIN
FL81934Medicare ID - Type Unspecified