Organization Name: | JUAN A. MALDONADO MD INC |
NPI Number: | 1972819225 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JUAN A MALDONADO (PRESIDENT) |
Mailing Address: | 404 Se 11th St Anadarko |
State: | OK US |
Postal Code: | 730054442 |
Phone Number: | 4052477346 |
Fax Number: | 4052477565 |
NPI Enumeration Date: | 08/25/2010 |
NPI Last Update Date: | 08/25/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 18749 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |