Provider Demographics
NPI:1659316909
Name:MAHFOOD, J PAUL (MD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:PAUL
Last Name:MAHFOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:549 NW LAKE WHITNEY PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1606
Mailing Address - Country:US
Mailing Address - Phone:772-879-2228
Mailing Address - Fax:772-879-2208
Practice Address - Street 1:549 NW LAKE WHITNEY PL
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1606
Practice Address - Country:US
Practice Address - Phone:772-879-2228
Practice Address - Fax:772-879-2208
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2011-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 65617207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280671100Medicaid
FLAE677YMedicare PIN
FL280671100Medicaid