Healthcare Provider Details

I. General information

NPI: 1942229166
Provider Name (Legal Business Name): JAMES PAUL MAYNARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 N GRAND AVE 6TH FL
FORT THOMAS KY
41075-1793
US

IV. Provider business mailing address

2590 SPRING MILL PL
BURLINGTON KY
41005-8501
US

V. Phone/Fax

Practice location:
  • Phone: 859-572-3452
  • Fax: 859-572-3414
Mailing address:
  • Phone: 859-586-2214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number40199
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number40199
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number40199
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: