Healthcare Provider Details

I. General information

NPI: 1801821145
Provider Name (Legal Business Name): AMY MAXWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N OREGON ST RADIOLOGY DEPT
EL PASO TX
79902-3524
US

IV. Provider business mailing address

PO BOX 277711
ATLANTA GA
30384-7711
US

V. Phone/Fax

Practice location:
  • Phone: 915-521-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberM3317
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: