Provider Demographics
NPI:1508488263
Name:MAXVAX, LLC
Entity Type:Organization
Organization Name:MAXVAX, LLC
Other - Org Name:MAXVAX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-233-3506
Mailing Address - Street 1:320 1ST ST N STE 103
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6947
Mailing Address - Country:US
Mailing Address - Phone:833-432-4376
Mailing Address - Fax:
Practice Address - Street 1:320 1ST ST N STE 103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6947
Practice Address - Country:US
Practice Address - Phone:833-432-4376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty