=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396722443
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT JOSEPH MAXWELL, MD II M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2005
-----------------------------------------------------
Last Update Date | 01/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 335 GLESSNER AVE FL 5
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44903-2269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-522-2833
-----------------------------------------------------
Fax | 419-524-1619
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 725 CLIFTON BLVD
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44907-2284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-774-0295
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 35-068577
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------