Provider Demographics
NPI:1306813662
Name:MAULDIN, JAMES E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:MAULDIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 847176
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7176
Mailing Address - Country:US
Mailing Address - Phone:903-237-1800
Mailing Address - Fax:903-237-1810
Practice Address - Street 1:2904 N 4TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5129
Practice Address - Country:US
Practice Address - Phone:903-753-4603
Practice Address - Fax:903-757-5045
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF9792207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128284007Medicaid
TX128284007Medicaid
TXTXB148103Medicare PIN