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General NPI Number Information
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NPI Number | 1144681255
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Entity Type | Individual
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Provider Name | LUKE MAXFIELD D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/16/2016
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 607 BEAMAN ST
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City | CLINTON
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State | NC
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Zip | 28328-2603
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Country | US
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Telephone | 910-596-5421
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Fax | 412-712-8567
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Provider Business Mailing Address
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Address Line | 10298 WALDEN ST
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City | SODDY DAISY
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State | TN
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Zip | 37379-5152
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Country | US
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Telephone |
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Fax | 412-712-8567
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 2020-03771
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 2020-03771
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 4372
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 4372
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License Number State | TN
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