Basic Information
| Provider Information | |||||||||
| NPI: | 1871601658 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAYNARD | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478074214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122423125 | ||||||||
| FaxNumber: | 8122423446 | ||||||||
| Practice Location | |||||||||
| Address1: | 1739 N 4TH ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478044002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122423110 | ||||||||
| FaxNumber: | 8122423446 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 08/18/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 01033888A | IN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 100251390 | 05 | IN | MEDICAID | 020009023 | 01 | RAILROAD MCARE PALAMETTO | OTHER | P00830679 | 01 | IN | RAILROAD MEDICARE | OTHER | 000000089639 | 01 | ANTHEM | OTHER |