Provider Demographics
NPI:1386064673
Name:AMY MAXWELL MD PA
Entity type:Organization
Organization Name:AMY MAXWELL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:ESCARZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-740-5122
Mailing Address - Street 1:PO BOX 220122
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-2122
Mailing Address - Country:US
Mailing Address - Phone:915-740-5122
Mailing Address - Fax:
Practice Address - Street 1:10501 GATEWAY BLVD W
Practice Address - Street 2:SUITE 140
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7934
Practice Address - Country:US
Practice Address - Phone:915-544-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM33172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty