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General NPI Number Information
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NPI Number | 1689070591
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Entity Type | Organization
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Legal Business Name | MAXWELL MEDICAL GROUP
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 11000 N SCOTTSDALE RD #225
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-5235
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Country | US
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Telephone | 602-508-8055
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Fax | 602-508-8325
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Provider Business Mailing Address
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Address Line | 11000 N SCOTTSDALE RD #225
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-5235
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Country | US
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Telephone | 602-508-8055
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Fax | 602-508-8325
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Authorized Official
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Title or Position | PRESIDENT
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Name | HAL B WILSON
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Credential | M.D.
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Telephone | 602-508-8055
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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 | 22876
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License Number State | AZ
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