Individual
DR. MARK JUSTIN MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5201 HARRY HINES BLVD, GRADUATE MEDICAL EDUCATION, DALLAS, TX 75235-7708
(214) 590-8058
Mailing address
2131 KESSLER CT, DALLAS, TX 75208-2951
(951) 660-3064
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
P8945
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2012
Last updated
09/02/2016
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