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General NPI Number Information
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NPI Number | 1295722668
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Entity Type | Individual
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Provider Name | RALPH MARTIN MAXWELL DO
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Gender | Male
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 811 HIGHWAY 65 S
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City | DUMAS
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State | AR
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Zip | 71639-3006
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Country | US
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Telephone | 870-382-8261
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Fax | 870-382-8140
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Provider Business Mailing Address
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Address Line | 811 HIGHWAY 65 S PO BOX 830
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City | DUMAS
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State | AR
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Zip | 71639-3006
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Country | US
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Telephone | 870-382-8261
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Fax | 870-382-8140
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 00356
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License Number State | ID
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