MEDICARE: PENELOPE MAYNARD M.D.

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	C-5264	AR

General Provider Information

NPI Number	:	1558333450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PENELOPE MAYNARD M.D.

Provider Business Mailing Address
First Line	:	760 EAST AVE
Second Line	:	SUITE A
City	:	PENSACOLA
State	:	FL
Zip	:	32508-5136
Country	:	US
Telephone Number	:	850-452-8970
Fax Number	:	850-452-8978

Provider Business Practice Location Address
First Line	:	760 EAST AVE
Second Line	:	SUITE A
City	:	PENSACOLA
State	:	FL
Zip	:	32508-5136
Country	:	US
Telephone Number	:	850-452-8970
Fax Number	:	850-452-8978

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	07/08/2007

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