Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 31471 | MN |
N | 2080P0214X | Pediatric Pulmonologist | 31471 | MN |
NPI | 1518971191 |
---|---|
Provider Name | Dr. Roy C Maynard |
First Address | Minneapolis, MN 55404-4289 |
Second Address | Minneapolis, MN 55404-4289 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 19/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E71246 | (02) | MN |