Individual
LARRY KEVIN MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
80 NE 758TH ST, OLD TOWN, FL 32680-9678
(352) 542-1635
(352) 542-1634
Mailing address
80 NE 758TH ST, OLD TOWN, FL 32680-9678
(352) 542-1635
(352) 542-1634
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
09/09/2014
Last updated
09/09/2014
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