Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME143063 | FL |
N | 111NI0900X | Internist | ME143063 | FL |
Y | 2080P0214X | Pediatric Pulmonologist | ME74522 | FL |
NPI | 1598779811 |
---|---|
Provider Name | Dr. Kevin D. Maupin |
First Address | Jacksonville, FL 32256-0532 |
Second Address | Pensacola, FL 32514-6094 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 18/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009713350 | (05) | AL |
0123108 | (05) | MS |
253119400 | (05) | FL |
E77874 | (02) |