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NPI Code Detail

MEDICARE: VICTOR A MAQUERA MD

MEDICARE:   VICTOR A MAQUERA  MD
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
12084N0400XNeurology PhysicianME59449FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3130013419OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11891786059OTHERFLNPI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891786059
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTOR A MAQUERA MD
Provider Business Mailing Address
First Line : PO BOX 17809
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32245-7809
Country : US
Telephone Number : 904-723-5665
Fax Number : 904-338-0951
Provider Business Practice Location Address
First Line : 1895 KINGSLEY AVE
Second Line : STE 903
City : ORANGE PARK
State : FL
Zip : 32073-4466
Country : US
Telephone Number : 904-276-1663
Fax Number : 904-276-2469
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2005
Last Update Date : 01/06/2011

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Directions to “ VICTOR A MAQUERA MD” Practice Location

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