Healthcare Provider Details

I. General information

NPI: 1063559433
Provider Name (Legal Business Name): RICHARD H MAUGHON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 W 23RD ST STE A
PANAMA CITY FL
32405-2370
US

IV. Provider business mailing address

210 S MAIN ST
CRESTVIEW FL
32536-3737
US

V. Phone/Fax

Practice location:
  • Phone: 850-226-6801
  • Fax: 877-413-5104
Mailing address:
  • Phone: 850-226-6801
  • Fax: 877-413-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number21909
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME86494
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: