Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 27823 | NC |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 27823 | NC |
NPI | 1063507739 |
---|---|
Provider Name | Dr. Keith M Maxwell |
First Address | Salt Lake City, UT 84127-0877 |
Second Address | Asheville, NC 28803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 28/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1114G | BCBS OF NC PROVIDER NUMBE (01) | NC |
200038382 | MEDICARE RR PROVIDER NUMB (01) | NC |
891114G | (05) | NC |
A3023 | MEDCOST PROVIDER NUMBER (01) | NC |
C82277 | (02) | NC |
P00916635 | RR MEDICARE (01) | NC |