Provider Demographics
NPI:1487642294
Name:MAH, CALVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:
Last Name:MAH
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:PMB #140
Mailing Address - Street 2:9838 OLD BAYMEADOWS RD.
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11808 SAN JOSE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-1862
Practice Address - Country:US
Practice Address - Phone:904-854-9600
Practice Address - Fax:904-854-4667
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16846OtherBCBS NUMBER
FL16846OtherBCBS NUMBER
FLI26041Medicare UPIN