Provider Demographics
NPI:1114019361
Name:MAGGIORE, JAY (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:MAGGIORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5619 GULF DRIVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:707 JENKS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2586
Practice Address - Country:US
Practice Address - Phone:850-747-5272
Practice Address - Fax:850-747-5274
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0400X
FLME22443207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37192OtherBLUE CROSS BLUE SHIELD
FL37192OtherBLUE CROSS BLUE SHIELD