Individual
ALLEN MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
PA953
KY
363A00000X
Physician Assistant
Primary
PA953
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
71000055500
—
KY
01
—
P0131826
RR MEDICARE PTAN
KY
Enumeration date
11/20/2007
Last updated
07/16/2014
Update your record
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