Provider Demographics
NPI:1790195469
Name:MAIER, ALBERT CARL
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:CARL
Last Name:MAIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 COUNTY ROAD 207A
Mailing Address - Street 2:
Mailing Address - City:EAST PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32131-4145
Mailing Address - Country:US
Mailing Address - Phone:386-326-0992
Mailing Address - Fax:
Practice Address - Street 1:358 COUNTY ROAD 207A
Practice Address - Street 2:
Practice Address - City:EAST PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32131-4145
Practice Address - Country:US
Practice Address - Phone:386-326-0992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0022140207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1053407734Medicare PIN