Provider Demographics
NPI:1982683611
Name:MAIZE, JOHN C SR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:MAIZE
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:135 RUTLEDGE AVE FL 11
Practice Address - Street 2:MSC 578
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8903
Practice Address - Country:US
Practice Address - Phone:843-792-9784
Practice Address - Fax:843-792-9804
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2020-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC009663207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC096639Medicaid
SCC60176Medicare UPIN