Healthcare Provider Details

I. General information

NPI: 1275534315
Provider Name (Legal Business Name): PAUL DAVID MAAS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 PARK ST N
ST PETERSBURG FL
33709-1042
US

IV. Provider business mailing address

5301 PARK ST N
ST PETERSBURG FL
33709-1042
US

V. Phone/Fax

Practice location:
  • Phone: 727-545-4545
  • Fax: 727-548-1360
Mailing address:
  • Phone: 727-545-4545
  • Fax: 727-548-1360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number053480
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: