Healthcare Provider Details

I. General information

NPI: 1063507739
Provider Name (Legal Business Name): KEITH M MAXWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 TURTLE CREEK DR
ASHEVILLE NC
28803
US

IV. Provider business mailing address

PO BOX 27877
SALT LAKE CITY UT
84127-0877
US

V. Phone/Fax

Practice location:
  • Phone: 828-274-4555
  • Fax: 828-274-3615
Mailing address:
  • Phone: 828-694-8385
  • Fax: 828-694-7654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number27823
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number27823
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: