Healthcare Provider Details

I. General information

NPI: 1982683611
Provider Name (Legal Business Name): JOHN C MAIZE SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 RUTLEDGE AVE FL 11 MSC 578
CHARLESTON SC
29425-8903
US

IV. Provider business mailing address

PO BOX 751461
CHARLOTTE NC
28275-1461
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-9784
  • Fax: 843-792-9804
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number009663
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: