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General NPI Number Information
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NPI Number | 1114963618
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Entity Type | Individual
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Provider Name | DWAYNE ALAN MAULTSBY MD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 7154 N UNIVERSITY DR #316
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City | TAMARAC
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State | FL
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Zip | 33321-2916
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Country | US
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Telephone | 954-720-3188
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Fax | 954-586-2589
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Provider Business Mailing Address
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Address Line | PO BOX 640996
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City | MIAMI
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State | FL
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Zip | 33164
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Country | US
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Telephone | 954-720-3188
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Fax | 954-586-2589
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME106616
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License Number State | FL
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