Doctor Name: | JOHN MAXWELL |
NPI Number: | 1649694035 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | G6345 |
Business Practice Address: | 12817 Hacienda Rdg Austin, TX - 787387652 |
Business Phone Number: | 5124151555 |
Business Fax Number: | |
Mailing Address: | 12817 Hacienda Rdg, AUSTIN |
State: | TX |
Postal Code: | 787387652 |
Phone Number: | 5124151555 |
Fax Number: | |
NPI Enumeration Date: | 02/06/2014 |
NPI Last Update Date: | 02/06/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | G6345 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |