Individual
DR. NICOLAS KATKHORDEH MAYNARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1402 S GRAND BLVD RM M260, SAINT LOUIS, MO 63104-1004
(314) 617-2359
Mailing address
1402 S GRAND BLVD RM M260, SAINT LOUIS, MO 63104-1004
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/10/2023
Last updated
06/25/2024
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