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Individual

DUSTIN ROSS MAYNE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
2900 DOOLITTLE DR, ELLSWORTH AFB, SD 57706
(937) 641-3000
(937) 641-5931
Mailing address
2900 DOOLITTLE DR, ELLSWORTH AFB, SD 57706-4821
(937) 641-3000
(937) 641-5931

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
1780
NE

Other

Enumeration date
03/08/2016
Last updated
08/05/2019
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