Provider Demographics
NPI:1770520728
Name:MAYNARD, STEVEN R (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:MAYNARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1901 S UNION AVE STE B3010
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1803
Mailing Address - Country:US
Mailing Address - Phone:253-383-5628
Mailing Address - Fax:253-383-5687
Practice Address - Street 1:1901 S UNION AVE STE B3010
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1803
Practice Address - Country:US
Practice Address - Phone:253-383-5628
Practice Address - Fax:253-383-5687
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60474298207V00000X, 207V00000X
MA77903207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1770520728OtherNPI
DC137271YT2Medicare PIN