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General NPI Number Information
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NPI Number | 1972515831
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Entity Type | Individual
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Provider Name | EDWARD MAXWELL PA
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Gender | Male
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 05/20/2013
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Provider Practice Location Address
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Address Line | 4800 FREDERICKSBURG RD SUITE 127
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3628
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Country | US
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Telephone | 210-733-5072
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Fax | 210-733-8649
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Provider Business Mailing Address
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Address Line | PO BOX 1239
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City | TROY
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State | MI
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Zip | 48099-1239
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Country | US
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Telephone | 248-824-6600
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Fax | 248-324-1477
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA01907
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA01907
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License Number State | TX
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