Provider Demographics
NPI:1437396660
Name:BYNUM, MAURICE
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:BYNUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5360 SW24TH STREET
Mailing Address - Street 2:
Mailing Address - City:WEST PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023
Mailing Address - Country:US
Mailing Address - Phone:305-762-2836
Mailing Address - Fax:
Practice Address - Street 1:5360 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:WEST PARK
Practice Address - State:FL
Practice Address - Zip Code:33023-3151
Practice Address - Country:US
Practice Address - Phone:305-762-2836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0066482374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide