Healthcare Provider Details

I. General information

NPI: 1649243114
Provider Name (Legal Business Name): MICHAEL H MAHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 PENMAN RD
NEPTUNE BEACH FL
32266-3175
US

IV. Provider business mailing address

1807 PENMAN RD
NEPTUNE BEACH FL
32266-3175
US

V. Phone/Fax

Practice location:
  • Phone: 904-200-2580
  • Fax: 904-200-2580
Mailing address:
  • Phone: 904-202-1032
  • Fax: 904-376-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME98797
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: