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General NPI Number Information
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NPI Number | 1114019361
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Entity Type | Individual
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Provider Name | JAY MAGGIORE M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 707 JENKS AVE SUITE A
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City | PANAMA CITY
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State | FL
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Zip | 32401-2586
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Country | US
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Telephone | 850-747-5272
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Fax | 850-747-5274
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Provider Business Mailing Address
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Address Line | 5619 GULF DRIVE
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32408
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME22443
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License Number State | FL
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