Provider Demographics
NPI:1831286863
Name:MAHER, PHILIP COLBURN (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:COLBURN
Last Name:MAHER
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 1:1717 N E ST
Mailing Address - Street 2:SUITE 422
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-6339
Mailing Address - Country:US
Mailing Address - Phone:850-469-0642
Mailing Address - Fax:850-437-8318
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:SUITE 422
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6339
Practice Address - Country:US
Practice Address - Phone:850-469-0642
Practice Address - Fax:850-437-8318
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118973207T00000X
AL26485207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010836000Medicaid
AL528201860Medicaid
I31092Medicare UPIN
AL528201860Medicaid