Individual
DR. SHAWN MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2900 1ST AVE, ROOM 1025, HUNTINGTON, WV 25702-1241
(304) 399-7484
(304) 399-7579
Mailing address
5170 US ROUTE 60, HUNTINGTON, WV 25705-2004
(304) 528-4600
(304) 399-0015
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
24520
WV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810020815
—
WV
Enumeration date
06/23/2008
Last updated
10/25/2021
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