Maynard, John C

Maynard, John C is an individual health care provider with primary practice located at 612 Roxbury Rd , Rockford IL 61107-5089. He recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as his primary health care specialty. Maynard, John C can be contacted via phone (815) 227-8300.

Contact Information

Primary practice address
612 Roxbury Rd Rockford IL 61107-5089
Fax: (815) 227-8301
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 036066422 Illinois

Profile Details

NPI number 1730180878
LBN Legal business name Maynard, John C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 10th, 2005
Last updated Apr 22nd, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730180878 NPPES
Wisconsin MEDICAID 30525600
Wisconsin Other P00605020
Wisconsin MEDICAID 036066422
Wisconsin Other 1616108

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