Individual
DR. RUSSELL VAUGHN MAPLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7222 ENGLE ROAD, FORT WAYNE, IN 46804-2222
(260) 432-5005
(260) 432-6003
Mailing address
7222 ENGLE ROAD, FORT WAYNE, IN 46804-2222
(260) 432-5003
(260) 432-6003
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
01058221A
IN
207K00000X
Allergy & Immunology Physician
019557
GA
207K00000X
Allergy & Immunology Physician
17076
SC
207K00000X
Allergy & Immunology Physician
MD - 11810
HI
207RP1001X
Pulmonary Disease Physician
01058221A
IN
207RP1001X
Pulmonary Disease Physician
019557
GA
207RP1001X
Pulmonary Disease Physician
17076
SC
207RP1001X
Pulmonary Disease Physician
MD - 11810
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000024268
M-PLAN
—
01
—
000000298856
ANTHEM BCBS
—
01
—
10987543
CAQH
—
01
—
1597162009
CIGNA
—
05
—
200460250
—
IN
01
—
352007446100
CARESOURCE
—
01
—
4395006
AETNA
—
01
—
P00153026
RAILROAD MEDICARE
—
Enumeration date
04/10/2006
Last updated
03/14/2012
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