Healthcare Provider Details

I. General information

NPI: 1982098133
Provider Name (Legal Business Name): MAXWELL MATHIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EVERETT DR
OKLAHOMA CITY OK
73104-5047
US

IV. Provider business mailing address

1200 EVERETT DR
OKLAHOMA CITY OK
73104-5047
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5215
  • Fax:
Mailing address:
  • Phone: 405-271-5215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38172
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number38172
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: