Provider Demographics
NPI:1699723692
Name:MAXWELL, MARK E (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:MAXWELL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5055 E BROADWAY BLVD
Mailing Address - Street 2:SUITE A-100 ACP
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3640
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:4532 E CAMP LOWELL
Practice Address - Street 2:ARIZONA COMMUNITY PHYSICIANS PC
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712
Practice Address - Country:US
Practice Address - Phone:520-323-3130
Practice Address - Fax:520-547-5621
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-02-26
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Provider Licenses
StateLicense IDTaxonomies
AZ22169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F79064Medicare UPIN