Provider Demographics
NPI:1336926559
Name:JEANTY, MAX DONALD (MHSC, PA-C)
Entity type:Individual
Prefix:MR
First Name:MAX
Middle Name:DONALD
Last Name:JEANTY
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Gender:M
Credentials:MHSC, PA-C
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Mailing Address - Street 1:PO BOX 100128
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0128
Mailing Address - Country:US
Mailing Address - Phone:352-265-9928
Mailing Address - Fax:352-627-4173
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-6014
Practice Address - Country:US
Practice Address - Phone:352-265-9928
Practice Address - Fax:352-627-4173
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2024-08-07
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Provider Licenses
StateLicense IDTaxonomies
FLPA9117853363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant