Provider Demographics
NPI:1275687881
Name:MAYCON, ZEV RANDY (MD)
Entity Type:Individual
Prefix:
First Name:ZEV
Middle Name:RANDY
Last Name:MAYCON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 E STATE ST
Mailing Address - Street 2:SUITE G110
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4957
Mailing Address - Country:US
Mailing Address - Phone:330-829-0951
Mailing Address - Fax:330-596-8696
Practice Address - Street 1:270 E STATE ST
Practice Address - Street 2:SUITE G110
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4957
Practice Address - Country:US
Practice Address - Phone:330-829-0951
Practice Address - Fax:330-596-8696
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072264M207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
100011544OtherRAILROAD MEDICARE
OH2020888Medicaid
G45905Medicare UPIN
OHMA0819651Medicare ID - Type Unspecified