Individual
DR. JONATHAN RAY MAYNARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2301 LEXINGTON AVE STE 135, ASHLAND, KY 41101-2800
(606) 408-8400
(606) 408-6770
Mailing address
PO BOX 1595, ASHLAND, KY 41105-1595
(606) 408-6200
(606) 408-6612
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
44675
KY
208000000X
Pediatrics Physician
TP960
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0050712
—
OH
05
—
3810021011
—
WV
05
—
7100173180
—
KY
Enumeration date
04/29/2008
Last updated
12/01/2021
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