MEDICARE: DR. JAMES E MAULDIN JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	F9792	TX
2	207V00000X	Obstetrics & Gynecology Physician	F9792	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306813662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES E MAULDIN JR. MD

Provider Business Mailing Address
First Line	:	2904 4TH ST STE 101A
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75605-5129
Country	:	US
Telephone Number	:	903-753-4603
Fax Number	:	903-757-5045

Provider Business Practice Location Address
First Line	:	2904 N 4TH ST
Second Line	:	SUITE 101
City	:	LONGVIEW
State	:	TX
Zip	:	75605-5129
Country	:	US
Telephone Number	:	903-753-4603
Fax Number	:	903-757-5045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	07/19/2024

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