Provider Demographics
NPI:1740219229
Name:MAYNARD, MALEA PRUSZENSKI (MD)
Entity Type:Individual
Prefix:DR
First Name:MALEA
Middle Name:PRUSZENSKI
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:8080 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 1650
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-1838
Mailing Address - Country:US
Mailing Address - Phone:972-860-8648
Mailing Address - Fax:972-860-8679
Practice Address - Street 1:13350 TI BLVD
Practice Address - Street 2:M/S 327
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1512
Practice Address - Country:US
Practice Address - Phone:972-671-9504
Practice Address - Fax:972-671-7096
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK7451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00240298OtherRR MEDICARE
TX8147K4OtherBCBS
TXP00240298OtherRR MEDICARE
TX08147KMedicare ID - Type Unspecified