Provider Demographics
NPI:1659637825
Name:LINDA MAYNARD MD PA
Entity Type:Organization
Organization Name:LINDA MAYNARD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-270-2710
Mailing Address - Street 1:PO BOX 14798
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-4798
Mailing Address - Country:US
Mailing Address - Phone:850-270-2710
Mailing Address - Fax:850-270-2720
Practice Address - Street 1:2365 CENTERVILLE RD STE L-1
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4317
Practice Address - Country:US
Practice Address - Phone:850-270-2710
Practice Address - Fax:850-270-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79385261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47953OtherBCBSFL
FL47953OtherBCBSFL