Provider Demographics
NPI:1689803603
Name:MAPLES, NATHAN DUDLEY (MD)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:DUDLEY
Last Name:MAPLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:501 MARSHALL ST STE 500
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1615
Mailing Address - Country:US
Mailing Address - Phone:601-948-1411
Mailing Address - Fax:601-948-0090
Practice Address - Street 1:501 MARSHALL ST STE 500
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1615
Practice Address - Country:US
Practice Address - Phone:601-948-1411
Practice Address - Fax:601-948-0090
Is Sole Proprietor?:No
Enumeration Date:2009-07-12
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS23098208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS350372YYWNMedicare PIN