Healthcare Provider Details

I. General information

NPI: 1114019361
Provider Name (Legal Business Name): JAY MAGGIORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 JENKS AVE SUITE A
PANAMA CITY FL
32401-2586
US

IV. Provider business mailing address

5619 GULF DRIVE
PANAMA CITY BEACH FL
32408
US

V. Phone/Fax

Practice location:
  • Phone: 850-747-5272
  • Fax: 850-747-5274
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME22443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: