Provider Demographics
NPI:1952633158
Name:J PAUL MAHFOOD MD INC
Entity type:Organization
Organization Name:J PAUL MAHFOOD MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MAHFOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-879-2228
Mailing Address - Street 1:549 NW LAKE WHITNEY PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1606
Mailing Address - Country:US
Mailing Address - Phone:772-879-2228
Mailing Address - Fax:772-879-2208
Practice Address - Street 1:549 NW LAKE WHITNEY PL
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1606
Practice Address - Country:US
Practice Address - Phone:772-879-2228
Practice Address - Fax:772-879-2208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 65617207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG44657Medicare UPIN
FLAE677YMedicare PIN