Provider Demographics
NPI:1902189251
Name:MAYFIELD, DOUGLAS GORDON (RPH)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:GORDON
Last Name:MAYFIELD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10161 SW 80TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3908
Mailing Address - Country:US
Mailing Address - Phone:305-274-6564
Mailing Address - Fax:305-595-3542
Practice Address - Street 1:11690 SW 72ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2691
Practice Address - Country:US
Practice Address - Phone:305-595-3546
Practice Address - Fax:305-595-3542
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 16891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist