Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 01022037A | IN |
NPI | 1043205800 |
---|---|
Provider Name | Douglas Maxwell |
First Address | Indianapolis, IN 46260-5379 |
Second Address | Indianapolis, IN 46227-0873 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2005 |
Last Update Date | 22/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100099210 | (05) | IN |
C24248 | (02) |