Provider Demographics
NPI:1306813662
Name:MAULDIN, JAMES E JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:MAULDIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2904 4TH ST STE 101A
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5129
Mailing Address - Country:US
Mailing Address - Phone:903-753-4603
Mailing Address - Fax:903-757-5045
Practice Address - Street 1:2904 N 4TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5129
Practice Address - Country:US
Practice Address - Phone:903-753-4603
Practice Address - Fax:903-757-5045
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9792208D00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128284007Medicaid
TX128284007Medicaid
TXTXB148103Medicare PIN