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NPI Code Detail

MEDICARE: DR. MARY MAILLOUX MD

MEDICARE: DR. MARY MAILLOUX 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
1207P00000XEmergency Medicine PhysicianME62993FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
123714OTHERFLMEDICARE CORE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760485437
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY MAILLOUX MD
Provider Business Mailing Address
First Line : 4074 SW 101ST AVE
Second Line :
City : DAVIE
State : FL
Zip : 33328-2205
Country : US
Telephone Number : 954-476-5891
Fax Number :
Provider Business Practice Location Address
First Line : 3333 W COMMERCIAL BLVD
Second Line : STE 210
City : FT LAUDERDALE
State : FL
Zip : 33309-3407
Country : US
Telephone Number : 877-751-1157
Fax Number : 919-425-1596
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 02/15/2008

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