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General NPI Number Information
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NPI Number | 1982095972
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Entity Type | Organization
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Legal Business Name | REUBEN MAGGARD M.D. P.A.
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Dates
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Enumeration Date | 02/11/2015
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 2001 KINGSLEY AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-5148
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Country | US
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Telephone | 606-233-5555
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Fax | 904-642-6262
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Provider Business Mailing Address
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Address Line | PO BOX 551099
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City | JACKSONVILLE
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State | FL
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Zip | 32255-1099
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Country | US
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Telephone | 606-233-5555
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Fax | 904-642-6262
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | WENDY C LU
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Credential |
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Telephone | 904-221-2535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | ME112969
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License Number State | FL
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