Provider Demographics
NPI:1750346227
Name:MAYNARD, STEVE MOHAMMED (DPM)
Entity type:Individual
Prefix:DR
First Name:STEVE
Middle Name:MOHAMMED
Last Name:MAYNARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8869 BLACKHEATH WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312
Mailing Address - Country:US
Mailing Address - Phone:305-527-3892
Mailing Address - Fax:305-320-6727
Practice Address - Street 1:1607 SAINT JAMES COURT
Practice Address - Street 2:VETERANTS HEALTH SYSTEM
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-878-0191
Practice Address - Fax:305-320-6727
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2504213E00000X
GAPOD000765213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390305200Medicaid
FL65432ZMedicare PIN
FLU63626Medicare UPIN
FL390305200Medicaid