MEDICARE: DR. BASSEM MAXIMOS MD, MPH, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	M7411	TX

General Provider Information

NPI Number	:	1063600013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BASSEM MAXIMOS MD, MPH, PA

Provider Business Mailing Address
First Line	:	651 N EGRET BAY BLVD # 270
Second Line	:	SUITE H
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2681
Country	:	US
Telephone Number	:	832-632-1333
Fax Number	:	832-632-1777

Provider Business Practice Location Address
First Line	:	651 N EGRET BAY BLVD FM270
Second Line	:	SUITE H
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2681
Country	:	US
Telephone Number	:	832-632-1333
Fax Number	:	832-632-1777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	09/16/2013

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