Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 007249 | ME |
NPI | 1588648323 |
---|---|
Provider Name | Dr. William Maxwell |
First Address | Portland, ME 04101-1823 |
Second Address | Portland, ME 04101-1823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002415 | ANTHEM BLUE SHIELD INDIV (01) | ME |
1040592 | AETNA PROV NUMBER (01) | ME |
C66124 | (02) | ME |
M20008401 | CIGNA INDIV ID NUMBER (01) | ME |
M2990 | CIGNA GROUP NUMBER (01) | ME |