Provider Demographics
NPI:1942229166
Name:MAYNARD, JAMES PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PAUL
Last Name:MAYNARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 SPRING MILL PL
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-8501
Mailing Address - Country:US
Mailing Address - Phone:859-586-2214
Mailing Address - Fax:
Practice Address - Street 1:85 N GRAND AVE 6TH FL
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1793
Practice Address - Country:US
Practice Address - Phone:859-572-3452
Practice Address - Fax:859-572-3414
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY401992084N0400X, 2084S0012X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2696435Medicaid
KY64127350Medicaid
KY64127350Medicaid
KYF28924Medicare UPIN
KY09454054Medicare PIN