Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 30-015780 | OH |
NPI | 1033188842 |
---|---|
Provider Name | Dr. James A Maxwell JR. |
First Address | Springfield, OH 45503-2737 |
Second Address | Springfield, OH 45503-2737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000075860 | ANTHEM (01) | OH |
0466839 | (05) | OH |
311107160026 | (05) | OH |
6082 | (05) | OH |
T47437 | (02) | OH |