Provider Demographics
NPI:1740216506
Name:MAYNARD, EUGENE H JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:H
Last Name:MAYNARD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-0399
Mailing Address - Country:US
Mailing Address - Phone:919-894-2011
Mailing Address - Fax:
Practice Address - Street 1:3333 NC HIGHWAY 242 N
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-7844
Practice Address - Country:US
Practice Address - Phone:919-894-2011
Practice Address - Fax:919-894-7645
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401448207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8954993Medicaid
NC2224282AMedicare ID - Type Unspecified
NC8954993Medicaid