Individual
DR. JOSE A. MAEDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
305 W 15TH ST, SUITE 204, LIBERAL, KS 67901-2455
(620) 624-4946
(620) 624-2260
Mailing address
PO BOX 1215, ATTN CLINIC BILLING OFFICE, LIBERAL, KS 67905-1215
(620) 629-6638
(620) 629-6684
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0436164
KS
208600000X
Surgery Physician
J1719
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200554440A
—
OK
05
—
201001320A
—
KS
Enumeration date
11/02/2006
Last updated
03/08/2017
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