MEDICARE: COLLEEN M MAYNARD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	R1H87	MO

General Provider Information

NPI Number	:	1538163035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN M MAYNARD M.D.

Provider Business Mailing Address
First Line	:	1004 CARONDELET DR
Second Line	:	STE 407
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-4836
Country	:	US
Telephone Number	:	816-942-3060
Fax Number	:	816-942-3141

Provider Business Practice Location Address
First Line	:	1004 CARONDELET DR
Second Line	:	STE 407
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-4836
Country	:	US
Telephone Number	:	816-942-3060
Fax Number	:	816-942-3141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/08/2007

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Directions to “ COLLEEN M MAYNARD M.D.” Practice Location

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