Provider Demographics
NPI:1538118575
Name:MAYNARD, PAUL RAMON (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:RAMON
Last Name:MAYNARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1390 US HIGHWAY 61 STE N1500
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4137
Mailing Address - Country:US
Mailing Address - Phone:636-933-8050
Mailing Address - Fax:636-933-8047
Practice Address - Street 1:1390 US HIGHWAY 61 STE N1500
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4137
Practice Address - Country:US
Practice Address - Phone:636-933-8050
Practice Address - Fax:636-933-8047
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003020138207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0901526OtherUNITED HEALTHCARE
MO208803502Medicaid
MO7919513OtherAETNA
MOP00073107OtherRAILROAD MEDICARE
MO186695OtherGROUP HEALTH PLAN
MO482650OtherHEALTHLINK
MO1283843OtherCIGNA
MO183352OtherBLUE CROSS BLUE SHIELD