Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 22268 | WV |
N | 208600000X | Surgeon | 22268 | WV |
Y | 2086S0120X | Pediatric Surgery | ME129852 | FL |
NPI | 1235146481 |
---|---|
Provider Name | Dr. Damian Maxwell |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33908-5769 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 29/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020940500 | (05) | FL |
3810006087 | (05) | WV |
I56003 | (02) | |
P00358613 | RAILROAD MEDICARE (01) | WV |