Healthcare Provider Details

I. General information

NPI: 1891292447
Provider Name (Legal Business Name): SETH L MAXWELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MEDICAL PARK DR STE 300
TAMPA FL
33613-4696
US

IV. Provider business mailing address

3000 MEDICAL PARK DR STE 300
TAMPA FL
33613-4696
US

V. Phone/Fax

Practice location:
  • Phone: 813-497-9661
  • Fax:
Mailing address:
  • Phone: 813-497-9661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS17647
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: