Provider Demographics
NPI:1215988704
Name:MAXWELL, REBECCA E M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:E M
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:EM
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:400 W IH 635 FWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3718
Mailing Address - Country:US
Mailing Address - Phone:972-869-2772
Mailing Address - Fax:972-869-1747
Practice Address - Street 1:400 W IH 635 FWY
Practice Address - Street 2:SUITE 210
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3718
Practice Address - Country:US
Practice Address - Phone:972-869-2772
Practice Address - Fax:972-869-1747
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06427363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX806N01OtherBCBS
TXP00902921OtherRAILROAD MEDICARE
TX272380YKY6Medicare PIN
TX806N01OtherBCBS