Provider Demographics
NPI:1205920410
Name:MACIEL, MAUREEN JORDAN (MD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:JORDAN
Last Name:MACIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16551 HUTCHISON RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-2324
Mailing Address - Country:US
Mailing Address - Phone:813-410-7791
Mailing Address - Fax:
Practice Address - Street 1:3100 E FLETCHER AVE STE 126
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4613
Practice Address - Country:US
Practice Address - Phone:813-467-4280
Practice Address - Fax:813-467-4281
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96694207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery