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General NPI Number Information
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NPI Number | 1952633158
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Entity Type | Organization
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Legal Business Name | J PAUL MAHFOOD MD INC
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Dates
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Enumeration Date | 02/12/2010
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Last Update Date | 11/22/2017
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Provider Practice Location Address
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Address Line | 549 NW LAKE WHITNEY PL SUITE 101
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-1606
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Country | US
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Telephone | 772-879-2228
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Fax | 772-879-2208
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Provider Business Mailing Address
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Address Line | 549 NW LAKE WHITNEY PL SUITE 101
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-1606
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Country | US
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Telephone | 772-879-2228
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Fax | 772-879-2208
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. J PAUL MAHFOOD
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Credential | M.D.
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Telephone | 772-879-2228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | ME 65617
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License Number State | FL
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