Provider Demographics
NPI:1801833215
Name:MAYNOR, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MAYNOR
Suffix:
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 788
Mailing Address - Street 2:
Mailing Address - City:FOLLY BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29439-0788
Mailing Address - Country:US
Mailing Address - Phone:843-425-2139
Mailing Address - Fax:
Practice Address - Street 1:SEVEN RIVERS REGIONAL MEDICAL CENTER
Practice Address - Street 2:6201 N.SUNCOAST BLVD
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428-6712
Practice Address - Country:US
Practice Address - Phone:352-795-6560
Practice Address - Fax:352-795-8369
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045114207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17647OtherBCBS
FLB92517Medicare UPIN
FL17647VMedicare ID - Type Unspecified