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General NPI Number Information
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NPI Number | 1346322427
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Entity Type | Individual
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Provider Name | JULIETTE RISTALINE PHELPS MAXWELL I M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 1833 BOULEVARD VA OUTPATIENT CLINIC
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City | JACKSONVILLE
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State | FL
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Zip | 32206-4382
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Country | US
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Telephone | 740-453-7725
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Fax |
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Provider Business Mailing Address
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Address Line | 8451 GATE PKWY W APT 1320
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4106
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Country | US
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Telephone | 740-526-0139
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35071084
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License Number State | OH
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