Maynard, Richard M
Maynard, Richard M is an sole proprietor health care provider with primary practice located at 110 Vista Dr , Pocatello ID 83201-5824. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Maynard, Richard M can be contacted via phone (208) 234-2300.Contact Information
Primary practice address
110 Vista Dr
Pocatello ID 83201-5824
Phone: (208) 234-2300
Fax: (208) 234-0026
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | O-93 | Idaho |
Profile Details
| NPI number | 1952395063 |
|---|---|
| LBN Legal business name | Maynard, Richard M |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 2nd, 2005 |
| Last updated | Feb 6th, 2014 - about 10 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1952395063 | NPPES |
| Idaho | MEDICAID | 002665300 | |
| Idaho | Other | DV104 | |
| Idaho | Other | 080179525 | |
| Idaho | Other | 000010003340 |
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